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Public  Protection  of  Maternity  and  Infancy 


HEARINGS 

BEFORE  THE 

COMMITTEE  ON  INTERSTATE  AND  FOEEIGN  COMMERCE 
OF  THE  HOUSE  OF  REPRESENTATIVES 

SIXTY-SEVENTH  CONGRESS 

FIRST  SESSION 

ON 


H.  R.  2366 


A  BILL  FOR  THE  PUBLIC  PROTECTION  OF 
MATERNITY  AND  INFANCY  AND  PROVIDING 
A  METHOD  OF  COOPERATION  BETWEEN  THE 
GOVERNMENT  OF  THE  UNITED  STATES  AND 
THE  SEVERAL  STATES 


JULY  12,  13,  14,  15,  16,  18,  19,  20,  21,  22,  23,  1921 


^ 


WASHINGTON 
GOVERNMENT  PRINTING   OFFICE 
74654  ia21 


PROTECTION  OF  MATERNITY: 


Committee  on  Interstate  and  Foreign  Commerce, 

House  op  Representatives, 

Tuesday,  July  12,  1921. 

The  committee  met  at  10  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

The  Chairman.  Gentlemen  of  the  committee,  we  now  have  a  quorum  and  can 
properly  proceed  to  the  business  of  the  morning.  This  day,  and  10  o'clock  this 
morning,  were  determined  as  the  time  for  l^eginning  the  consideration  of  a  bill  intro- 
duced by  Judge  Towner,  of  the  House,  which  is  denominated  as  H.  R..  2366.  The 
title  of  it  is,  "A  bill  for  the  public  protection  of  maternity  and  infancy,  and  providing 
a  method  of  cooperation  between  the  Government  of  the  United  States  and  the  several 
States." 

The  bill  was  considered  in  the  last  Congi'ess,  and  in  consequence  of  that  considera- 
tion a  contention  has  been  made  that  the  hearings  now  about  to  be  begun  should  be 
Wrtually  no  tiling;  that  the  record  of  the  last  hearings  was  sufficient  for  the  committee 
to  use  as  a  basis  for  arriving  at  their  conclusions.  It  would  seem,  however,  after  con- 
sidering the  question  and  in  view  of  the  many  new  interests  which  have  been  de- 
veloped, necesary  to  give  Very  careful  consideration  to  the  whole  subject.  I  want 
to  say  for  the  benefit  of  those  who  are  here  on  account  of  an  interest  in  the  bill,  from 
one  angle  or  another,  that  the  hearings  will  not  be  confined  necessarily  to  those  who 
are  for  or  against  the  bill.  We  have  entering  into  the  hearings  the  necessity  of  con- 
sidering the  work  which  is  now  going  on  under  the  direction  of  the  administration, 
the  President  of  the  United  States  and  the  Congi-ess;  the  commission  appointed  by 
Congress  to  look  into  the  various  departments  of  the  Government  with  a  \'iew  to 
making  a  report,  ultimately,  in  which  they  will  recommend  or  not,  as  they  choose, 
the  consolidation  of  departments  and  other  matters  which  are  related  thereto.  The 
President  of  the  United  States  has  created  a  commission,  the  head  of  which  is  Gen. 
Dawes.  That  commission  appears,  broadly  speaking,  to  have  something  of  the  same 
sort  in  mind.  Then,  again,  there  is  another  undertaking  at  the  instance  of  the  Presi- 
dent of  the  United  States  headed  by  Brig.  Gen.  Sawyer.  That  is  known  as  the  wel- 
fare department,  and  Gen.  Sawyer  and  those  connected  with  him  are  engaged  in  a 
study  of  the  departments  which  might  properly  come  under  such  a  division  of  Govern- 
ment as  is  contemplated  or  thought  of  in  connection  with  this  welfare  division. 

You  can  readily  see,  members  of  the  committee  and  those  who  are  here  in  interest, 
that  it  will  be  necessary  for  the  committee  not  only  to  hear  the  arguments  for  and 
against  this  particular  bill,  but  also  to  bear  in  mind  the  question  of  its  availability 
or  the  wisdom  of  legislating  on  it  at  this  time,  and  also  Aarious  other  aspects  which 
might  conflict  AA-ith  any  one  of  the  several  movements  directed  toward  consolidation 
and  concentration.  I  mention  these  matters  in  order  that  you  may  all  have  a  fair 
understanding  of  the  scope  of  these  hearings. 

I  A^-ish  to  say  it  is  rather  embarrassing  for  the  committee  to  be  obliged  to  mix  up  the 
possible  considerations  of  these  various  endeavors  in  order  to  work  out  efficient  and 
concentrated  methods  in  connection  with  the  consideration  of  the  actual  merits  of  tliis 
bill.  So  I  A\'ish,  quite  in  accord  with  what  has  been  my  particular  experience  A\"ith 
many  of  you,  personally  by  word  and  more  frequently  by  letter,  to  urge  you  to  possess 
your  souls  in  patience.  This  committee  has  not  sidestepped  nor  aA'oided  this  issue 
at  any  moment.  The  chairman  can  be  included  in  that  statement.  The  committee 
has.  however,  had  its  manifest  duties  to  perform  in  connection  with  the  Government 
of  the  United  States  and  the  possiljle  and  logical  operations  of  the  Congress.  We 
have  thus  far  undertaken  to  consider  matters  as  they  have  appeared  in  logical  order, 
with  a  \\Q.\\  to  fitting  in  with  the  general  program,  and  it  would  never  have  been  of 
any  avail  to  have  taken  np  this  bill  for  consideration,  so  far  as  its  passage  through  the 
House  is  to  be  considered.  It  could  not  have  been  reached.  We  therefore  come  to 
you,  I  believe — and  I  think  it  is  due  to  the  committee  to  haA-e  this  said — with  a 
frank,  flat  statement  that  this  bill  coming  up  to-day  is  really  in  logical  order  for  the 
first  time. 


6  PUBLIC   PROTECTION    OF    MATEENITY   AND   UsTFANCY, 

The  chairman  will  ask  Judge  Towner,  who  has  introduced  the  bill,  to  make  any 
statement  he  chooses  in  regard  to  presenting  the  side  of  those  in  favor  of  the  bill,  and 
we  shall  be  pleased,  if  possible,  to  act  in  accord  with  what  is  agreeable  to  him  and 
those  associated  with  him. 

Mr.  Towner.  Mr.  Chairman,  I  am  very  sure,  for  myself  and  for  the  supporters  of 
the  bill,  we  will  be  very  glad,  indeed,  to  act  upon  any  arrangement  for  the  hearing 
that  the  committee  may  determine.  If  you  suggest  that  the  time  should  be  divided 
between  those  who  are  for  the  bill  and  those  who  are  against  it,  we  are  perfectly  willing 
to  enter  into  any  arrangement  that  may  be  suggested  by  the  committee  as  to  time,  be 
it  a  small  or  a  long  time.  That,  of  course,  is  for  the  committee  to  determine.  We  are 
perfectly  willing  and  glad,  indeed,  to  act  upon  any  suggestion  or  any  rule  that  the 
committee  may  make  with  regard  to  the  hearing.  Does  the  chairman  desire  to 
suggest  any  particular  limitation  of  time? 

The  Chairman.  Judge  Towner,  the  committee  by  vote  directed  the  chairman  to 
undertake  to  find  out  from  those  who  contemplated  making  an  appearance  here  the 
amount  of  time  they  thought  would  be  needed  to  present  their  views,  and  to  ask  such 
leadership  as  there  happened  to  be,  if  any,  of  the  various  interests,  to  indicate  what 
time  they  thought  was  necessary.  After  a  little  conference  with  several  of  them,  it 
appeared  to  the  chairman  that  he  never  could  get  anywhere  in  that  inquiry  because 
the  situation  was  such  that  it  did  not  contribute  toward  that  sort  of  a  solution.  For 
instance — and  we  might  as  well  be  frank  about  this  entire  matter- — the  proponents  of 
the  bill  were  rather  in  favor  of  a  short  hearing.  That  statement  was  met  by  the 
opponents  of  the  bill  with  a  statement  to  the  effect  that  the  proponents  had  a  long 
and  successful  inning  when  the  bill  was  under  consideration  in  the  last  Congress,  but 
that  they,  in  turn,  for  some  reason  or  another,  did  not  seem  to  be  aware  of  the  fact  that 
the  hearing  was  going  on  in  time  to  get  their  forces  together  and  make  a  fair  and  proper 
representation  of  their  side.  So  that  if  the  committee  were  to  say  that  we  will  have 
so  many  definite  hours  and  we  will  assign  so  many  to  one  side  and  so  many  to  the 
other,  we  would  still  be  open  to  the  objection  that  one  side  would  perhaps  be  shut  off 
and  perhaps  in  the  end  the  opponents  would  feel  that  they  had  not  been  fairly 
considered. 

On  the  other  hand,  if  the  proponents  feel  that  the  testimony  given  in  the  last  Con- 
gress represents  fairly  their  side  and  they  are  willing  to  rest  on  it.  with  perhaps  a 
little  supplementary  testimony,  that  would  help  the  cause,  but  when  it  comes  to 
dividing  the  actual  number  of  hoius  between  the  two,  it  hardly  seems  practicable. 
Furthermore,  there  would  be  the  consideration  of  those  coming  in  from  the  outside 
who  would  be  asked  to  give  their  testimony  without  any  particular  regard  to  the 
merits  of  the  bill.  So  it  is  for  the  committee  to  determine  whether  or  not  they  will 
establish  so  many  hours,  but  so  far  as  the  chairman  is  concerned,  he  would  think, 
perhaps,  it  would  be  well  to  let  the  hearing  proceed  for  a  little  while  and  see  if  we  can 
gauge  the  possibilities,  and  then  come  to  some  conclusion  if  the  hearing  should  be 
too  much  drawn  out. 

Mr.  Towner.  I  presume  that  would,  perhaps,  be  best.  I  could  not  tell  anything 
about  what  time  would  be  occupied  with  the  indefinite  arrangement  suggested,  but 
we  are  perfectly  willing  to  act  upon  the  suggestion  of  the  chairman  and  will  proceed 
with  our  affirmative  testimony. 

The  Chairman.  Judge  Towner,  will  you  permit  one  more  interruption? 

]\Ir.  Towner.  Certainly. 

The  Chairman.  There  are  so  many  angles  to  this  question  that  I  found  it  impos- 
sible to  arrange  them  all  in  my  mind.  We  are  now  meeting  at  11  o'clock.  The  com- 
mittee has  previously  expressed  the  opinion  that  they  ought  to  stand  ready  to  adjourn 
these  hearings  at  11  o'clock  by  virtue  of  the  importance  of  the  legislative  business 
now  under  consideration.  It  might  be  helpful  if  from  day  to  day  we  could  decide 
just  what  we  would  do  when  the  hearings  opened,  and  I  would  like  to  take  this  occa- 
sion to  ask  the  committtee  to  express  themselves  in  respect  to  that  consideration,  so 
that  the  witnesses,  and  those  in  charge  of  them,  may  know,  at  the  opening  of  the 
session  just  what  program  they  will  have  to  follow  out.  This  morning  we  would 
have  about  50  minutes  if  we  adhered  to  the  previous  expression  of  the  committee. 
Will  the  committee  kindly  determine  that  here  and  now  so  that  Judge  Towner  and 
others  may  understand  the  situation. 

(Upon  motion  of  Mr.  Merritt,  the  committee  decided  to  sit  until  12  o'clock  subject 
to  roll  calls.) 


PUBLIC   PROTECTIOiSr    OF    MATERNITY   AND   INFANCY.  7 

STATEMENT  OF  HON.   HORACE  M.  TOWNER,  A  REPRESENTATIVE 
IN  CONGRESS  FROM  THE  STATE  OF  IOWA. 

Mr.  Towner.  Mr.  Chairman  and  gentlemen,  you  will,  perhaps,  remember  that 
during  the  last  Congress  the  original  bill  passed  the  Senate  and  also  was  reported  Ity 
this  committee  to  the  House,  l)ut  so  late  in  the  session  that  it  was  impossible  to  obtain 
action  on  the  bill  in  the  House.  However,  the  House  committee  made  a  considera})le 
numl)er  of  amendments,  and  at  the  commencement  of  this  Congress  both  Senator 
Sheppard  and  myself  reintroduced  the  bill  in  exactly  the  form  which  you  reported 
the  bill;  in  other  words,  incorporating  all  the  amendments  that  were  agreed  to  by 
this  committee  during  the  last  Omgress. 

During  the  present  Congress  hearings  have  been  held  in  the  Senate  committee,  and 
the  Senate  committee  has  reported  the  bill  to  the  Senate  favorably  with  certain 
amendments.  H  the  members  of  the  committee  would  like  to  have  me  go  through 
those  amendments  and  consider  them,  I  will  be  glad  to  do  so,  or  we  can  do  that  sub- 
sequently, just  as  you  suggest.  What  is  the  desire  of  the  committee  regarding  that 
matter? 

Mr.  Barkley.  Mr.  Chairman,  I  would  suggest  that  Judge  Towner  make  a  general 
statement  now,  and  that  the  matter  of  the  detailed  amendments  be  taken  up  later  on 
in  the  consideration  of  the  bill. 

Mr.  Towner.  Very  well.     I  will  be  glad  to  do  so. 

Now,  gentlemen  of  the  committee,  I  shall  not  at  this  time  take  the  time  of  the  com- 
mittee to  make  any  elaborate  statement  regarding  this  bill.  It  is  so  well  known  and 
your  time  is  so  precious  that  I  do  not  care  myself  to  occupy  much  time  now.  However, 
I  think  it  would  only  be  fair  that  I  should  have  an  opportunity,  after  the  close  of  the 
ol)jections  to  the  bill,  to  refer  to  them  as  briefly  as  possible. 

Gentlemen,  this  bill  has  attracted  a  great  deal  of  attention;  I  presume  as  much  be- 
cause of  the  opposition  to  the  bill  as  because  of  its  inherent  merit.  I  confess  that  I 
have  t)een  very  much  surprised  at  the  intensity  of  the  opposition  to  this  bill  from 
certain  quarters.  I  think  I  am  justified  in  saying  that  in  a  great  measure  that  arises 
from  an  entire  misapprehension  regarding  the  bill.  I  notice  in  glancing  over  the 
testimony  of  those  who  have  opposed  the  bill  that  in  some  way  or  other  they  seem  to 
assume  that  this  bill  creates  a  sort  of  overlordship  located  here  at  Washington,  over  all 
the  homes  in  the  country;  that  this  institution  is  to  ])e  created  for  the  purpose  of  de- 
termining just  what  the  members  of  the  families  of  the  people  of  the  United  States 
should  do. 

The  origin  of  this  bill,  gentlemen,  is  very  simple.  There  seems  to  exist  in  the  minds 
of  some  of  the  opponents  of  the  bill  the  idea  that  this  is  a  sort  of  conspiracy  hatched 
up  for  the  purpose  of  obtaining  this  great  power  over  the  people  of  the  United  States 
and  their  family  and  home  interests.  The  origin  of  this  bill  is  very  briefly  this:  The 
Children's  Biireau  here  in  Washington,  cooperating  with  other  institutions,  both 
public  and  private,  interested  in  child  welfare  all  over  the  United  States,  very  early 
in  their  work  came  to  a  recognition  of  this  very  important  and  terribly  tremendous 
fact,  that  there  was  in  the  United  States  an  unusual,  a  disgraceful  amount  of  mor- 
tality arising  from  maternity  cases,  both  as  to  the  mothers  and  the  children  of  the 
country.  They  also  found  out  that  there  was  a  vast  amount  of  apathy  regarding  this 
fact.'  It  seemed  to  be  sometimes  ignored,  but,  of  course,  in  most  cases  it  was  the 
result  mostly  of  ignorance  of  the  facts.  The  Children's  Bureau  began  making  an 
investigation  regarding  the  cause  of  this  and  regarding  the  possible  cure  of  it.  They 
found  out  that  in  the  vast  majority  of  cases  the  causes  were  of  two  general  classes, 
ignorance  and  want  of  financial  ability;  in  other  words,  poverty.  Of  course,  there 
were  other  influences  responsil^le  for  these  conditions,  but  these  seemed  to  be  the 
primary  ones. 

They  also  ascertained  the  still  more  important  fact  that  wherever  they  were  able 
to  estal)lish  in  the  States  or  in  the  cities  systematic  aid  in  these  maternity  cases, 
jjrincipally  of  a  nursing  and  helpful  character;  that  wherever  they  were  able  to  do 
this  they  decreased  this  shocking  mortality  almost  one-half,  and  in  some  cases  more 
than  one-half.  Of  course,  the  question  was  of  such  tremendous  importance  and  the 
remedy  appeared  to  be  so  effectual,  when  applied,  that  these  women  who  have  had 
this  child-welfare  work  in  their  charge  here  in  Washington,  joined  with  other  child- 
welfare  associations  all  over  the  United  States,  concluded  that  they  ought  to  do  some- 
thing here,  and  that  the  National  Government  ought  to  do  something,  to  stimulate 
the  activity  of  those  who  were  indifferent  and  to  aid  those  who  were  not  financially 
able  to  help  themselves.  So  this  bill  was  the  result  merely  of  those  conditions,  an 
effort  to  help,  an  effort  to  aid,  an  effort  to  stimulate  the  States  to  acti\'ity. 

Regarding  the  question  as  to  whether  or  not  this  establishes  an  authority  here  in 
the  city  of  Washington,  that  is  determined  to  take  over  and  impose  on  the  people  of 


8  PUBLIC   PROTECTION    OF   MATEENITY   AND   INFANCY. 

the  United  States  aid  or  assistance  in  these  cases,  whether  they  want  it  or  not,  I  think 
that  the  bill  is  a  sufficient  answer  by  its  terms  to  that  complaint. 

Let  me  say  to  you  gentlemen  that  if  there  is  anything  in  the  bill  yet  existing  that 
in  the  slightest  degi'ee  would,  in  your  judgment,  show  an  indication  of  autocratic 
i  exercise  of  power,  let  us  have  it  taken  out.  It  will  meet  with  no  objection  on  the 
^  part  of  the  proponents  of  this  bill.  It  is  to  aid,  to  encourage  and  to  stimulate,  not  to 
control.  If  you  will  examine  the  amendments  that  have  been  made  from  time  to 
time  you  will  see  that  they  have  all  been  made  with  the  desire  to  eliminate  any  possi- 
ble interpretation  of  that  sort. 

I  do  not  want  to  take  up  any  more  time  with  regard  to  the  bill  except  that  I  would 
be  glad  to  answer  any  questions  that  may  be  in  the  minds  of  any  of  the  members  of 
the  committee  before  I  introduce  the  other  speakers. 

Mr.  Chairman,  I  hand  to  you  a  communication  which  is  addressed  to  you  and  to 
the  committee  and  ask  for  such  consideration  of  it  as  you  see  fit  to  give  it.  I  also 
should  like  to  introduce,  either  at  this  time,  at  some  subsequent  time  or  from  time  to 
time,  as  the  gentlemen  of  the  committee  may  desire,  some  statements  in  the  form  of 
petitions,  not  to  enciunber  the  record  but  merely  to  indicate,  as  nearly  as  we  may,  the 
support  which  the  bill  is  receiving. 

I  assume,  gentlemen,  that  there  is  nothing  further  it  is  necessary  for  me  to  state, 
and  I  will  ask  the  committee  to  hear — — • 

Mr.  Cooper  (interposing).  Before  you  proceed  may  I  ask  you  a  question? 

Mr.  Towner.  Yes. 

Mr.  Cooper.  Is  it  your  attention  to  have  the  proponents  of  the  bill  speak  first  and 
then  the  opponents  of  the  bill  speak  after  that? 

Mr.  Towner.  I  have  been  perfectly  willing  to  agree  to  any  suggestion  that  might 
be  made.  I  suggested  that  the  proponents  of  the  bill  would  be  perfectly  willing  to 
hear  the  objections  and  then  introduce  their  testimony,  but  the  chairman  thought 
that  would  perhaps  not  be  fair  and,  of  course,  I  am  perfectly  willing  to  agree  to  any 
suggestion  or  arrangement  that  may  be  made. 

The  Chairman.  The  chairman  will  say  to  Mr.  Cooper  and  Judge  Towner  that  the 
logical  way  to  proceed  with  the  discussion  of  the  proposition,  as  we  understand  it,  is 
for  those  who  favor  it  to  appear  first. 

Mr.  Towner.  You  are  exactly  right. 

Mr.  Cooper.  It  seems  to  me  that  does  not  give  the  proponents  of  the  bill  any  chance 
for  rebuttal,  so  that  I  think  the  time  should  be  divided  between  the  opposition  and 
those  who  are  in  favor  of  the  bill. 

Mr.  Towner.  If  there  is  any  need  for  rebutting  testimony  I  am  quite  sure  the  com- 
mittee will  be  perfectly  willing  to  grant  an  opportunity  to  present  it. 

Mr.  Cooper.  If  that  will  be  done  I  am  perfectly  willing  to  go  along. 

Mr.  Towner.  I  am  perfectly  willing  to  leave  it  to  the  judgment  of  the  committee 
as  to  whether  or  not  that  shoidd  be  done. 

The  Chairman.  Unless  the  committee  sees  fit  to  change  the  order  we  will  proceed 
as  arranged. 

Mr.  Towner.  Mr.  Chairman,  I  ask  the  committee- to  hear  Dr.  S.  Josephine  Baker, 
who  is  the  director  of  the  child  hygiene  division  of  the  New  York  City  Board  of  Health. 

STATEMENT     OF    DR.     S.    JOSEPHINE    BAKER,    DIRECTOR    CHILD 
HYGIENE  DIVISION,  NEW  YORK  CITY  BOARD  OF  HEALTH. 

Dr.  Baker.  Mr.  Chairman  and  gentlemen  of  the  committee 

Mr.  Graham  (interposing).  Before  the  lady  proceeds,  may  I  inquire  whether  she 
wishes  to  be  interrupted? 

Dr.  Baker.  I  would  like  very  much  to  be  interrupted  and  would  like  to  have  the 
committee  ask  questions. 

I  appear  before  you  as  the  official  representative  of  the  department  of  health  of 
New  York  City,  the  commissioner  having  asked  me  to  present  to  you  the  testimony 
we  have  on  this  subject  in  the  hope  that  it  might  be  of  some  value  in,  perhaps,  clearing 
up  the  situation  which  seems  to  exist  in  regard  to  some  of  the  features  of  the  bill. 

We  have  had  in  New  York  the  honor,  I  believe,  of  having  been  the  originators  of 
child  hygiene  work  in  this  country,  and  we  have  had  there  for  13  years  a  bureau  of 
child  hygiene,  which  has  cared  for  the  health  of  the  children  of  the  city.  It  has  been 
a  rather  large  proposition,  because  we  have  about  135,000  births  a  year,  and  we  have 
approximately  1,000,000  children  in  our  public  and  parochial  schools.  The  city  has 
been  extremely  generous  in  its  appropriations  for  this  work,  the  budget  for  this  last 
year  amounting  to  about  $900,000,  and  we  feel  that  we  owe  to  the  citizens  of  New 
York,  as  well  as  to  the  citizens  of  the  country,  an  accounting  of  our  stewardship  as  to 
how  this  money  has  been  spent  and  whether  or  not  it  i.e  of  value  to  do  child  welfare 
work  in  any  community,  and  whether  you  can  make  a  definite  impression  upon  the 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY.  9 

liealtli  of  a  community  by  doing  it.  We  liave  carried  out  our  work  very  generally 
along  the  lines  which  are  provided  by  the  Sheppard-Towner  bill;  that  is,  simply 
giving  to  the  people  of  the  community  that  information  which  it  is  necessary  for  them 
to  have  in  order  that  they  may  keep  well. 

There  are,  as  you  proba])ly  know,  in  public  health  work  two  factors  which  are  always 
essential:  One  is  the  community  factor;  that  is,  the  community  must  provide  cer- 
tain things  for  the  people,  and  the  second  one  is  the  individual  factor.  A  person 
rnust  be  taught  how  to  use  the  tools  that  are  given  by  the  community.  As  an  illustra- 
tion, it  is  perfectly  ol>vious,  of  course,  that  it  is  useless  to  tell  a  mother  to  give  her  baby 
good  milk  if  the  community  does  not  provide  good  milk.  On  the  other  hand,  if  the 
community  provides  good  milk  and  we  do  not  tell  the  mother  how  to  keep  it  we  have 
been  lacking  in  one  of  the  very  essentials.  Consequently,  we  feel  we  have,  first,  the 
education  of  the  community  to  do  something  for  its  people,  and,  second,  the  instruction 
of  the  people  as  to  how  to  use  these  things  that  the  community  provides.  So  we  have 
carried  on  in  New  York  for  this  nuniber  of  years  work  looking  to  the  reduction  of  the 
maternal  and  infant  death  rate  and  for  the  better  health  of  the  children  of  all  ages. 

To  digress  for  a  minute,  it  has  been  rather  startling  to  us  in  New  York  and  a  matter 
of  a  good  deal  of  concern  to  have  brought  to  our  attention  the  figures  recently  gotten 
out  by  the  Children's  Bureau,  namely,  that  the  United  States  stands  seventeenth  on 
the  list  of  civilized  nations  of  the  world  in  its  maternal  death  rate,  and  eighth  on  the 
list  in  its  infant  death  rate,  a  position  which  is  appalling  and  of  which  we  ought  to  be 
heartily  ashamed.     There  is  no  doubt  about  that. 

Recently  we  have  had  testimony  from  William  Travis  Howard,  of  Johns  Hopkins 
University,  to  the  effect  that  the  maternal  death  rate  in  the  United  States,  as  he 
expresses  it,  is  more  than  double  the  Swedish  death  rate  and  120  per  cent  higher  than 
the  English  death  rate.     He  says: 

"These  rates,  although  calculated  by  a  method  more  favorable  than  that  used  in 
comparative  tables  in  which  stillbirths  are  not  taken  into  account,  are  probably 
unparalleled  in  modern  times  in  a  civilized  country." 

Mr.  Denison.  "Wrhat  authoritv  are  you  quoting? 

Dr.  Bake]{.  I  am  quoting  William  'Tra^^s  Howard,  who  is  at  the  head  of  the  depart- 
ment of  biometry  and  \dtal  statistics  of  .Johns  Hopkins  University.  He  has  written 
a  pamphlet  on  The  Real  Risk— Rate  of  Death  to  Mothers  from  Causes  Connected 
With  Childbirth.     I  am  reading  from  that  pamphlet. 

Mr.  Denison.  Is  that  a  recent  pamphlet? 

Dr.  Baker.  Yes;  it  was  published  in  jMarch  of  this  year. 

Mr.  Denison.  Do  you  know  upon  v/hat  he  bases  those  statistics? 

Dr.  Bakek.  He  bases  them  upon  the  official  statistics  of  the  birth  registration  area 
of  the  United  States  and  the  official  statistics  of  the  countries  in  question.  He  has 
compared  certain  European  cities,  where  vital  statistics  were  obtainable,  with,  certain 
American  cities,  such  as  Baltimore,  Philadelphia,  Boston,  and  New  York,  where 
vital  statistics  of  equal  credibility  could  be  obtained,  and  he  found  that  all  of  the" 
cities  in  the  United  States  ha\e  a  maternal  death  rate  which  is  very  much  higher 
indeed  than  the  maternal  death  rate  in  the  cities  that  were  studied  in  Europe. 

Mr.  Towner.  Except  New  York. 

Dr.  Baker.  I  was  going  to  say  that  an  interesting  thing  comes  out  there  and  that  is 
this:  Taking  the  United  States  cities  that  were  studied  he  finds  that  the  maternal 
death  rate,  based  upon  10,000  labors,  was  70.71  in  Boston,  64.89  in  Baltimore,  61.48 
m  Philadelphia,  46.11  in  New  York  City.  That  is  for  all  the  death  rates  of  mothers, 
but  when  you  come  to  the  preventable  death  rates  of  mothers— and  what  we  mean 
by  that  is  puerperal  septicemia  and  the  causes  we  know  are  preventable  by  the  type 
ot  work  Ave  are  doing — an  even  more  interesting  situation  develops. 

He  finds  that  New  Y'ork  City  has  not  only  the  lowest  preventable  maternal  mor- 
tality rates  of  the  cities  of  the  United  States,  but  has  a  lower  preventable  maternal 
mortality  rate  than  any  of  the  ciries  studied  in  Europe.  New  York  has  a  lower  pre- 
ventable maternal  mortality  rate  than  any  other  city  in  the  world  that  has  been 
studied.  I  am  presenting  these  figures  to  show  that  in  my  opinion  there  is  no  reason 
whatever  why  the  rest  of  the  United  States  should  be  suffering  under  this  tremendous 
blot  and  be  in  the  almost  criminal  condition  of  alloAving  these  mothers  to  die,  when 
a  city  like  New  Y^ork,  ^yiih  all  of  its  drawbacks,  can,  Avi'th  the  expenditure  of  a  small 
amount  of  money  and  the  use  ofwell-defined  methods,  reduce  its  maternal  mortality 
rate  to  this  point. 

Mr.  Newton.  Have  you  any  figiu-es  showing  the  mortahtv  rate  before  you  estab- 
lished your  child  hygiene  department  and,  if  so,  have  you"  compared  those  figures 
with  the  figures  in  other  countries? 

Dr.  Baker.  Yes;  you  Avill  find  those  figures  in  this  pamphlet  and  vou  will  also  find 
m  the  pamphlet  this  statement,  which  I  would  like  to  read  into  the  record: 


10  PUBLIC   PROTECTIOlSr    OF    MATERNITY  AND   INFANCY. 

"The  average  total  rate  from  all  diseases  connected  with  the  puerperal  state  for 
New  York  City,  (46.11  per  10,000  labors),  conspicuously  lower  than  that  for  any  of  the 
other  cities  of  the  United  States  under  consideration,  is  over  35  per  cent  higher  than 
that  for  Birmingham.  The  average  rate  for  puerperal  septicemia  is  not  only  lower 
than  that  for  Birmingham,  but  the  rate  for  this  affection  has  fallen  continuously 
throughout  the  5-year  period,  and  in  1919  reached  the  remarkably  low  figure  of 
11.41  per  10,000  labors.  The  reports  of  the  department  of  health  indicate  that  this 
result  has  been  materially  influenced  by  persistent  and  intelligently  directed  adminis- 
trative measures.  While  the  rates  (New  York  City)  for  the  other  categories  are  not  so 
low  as  those  for  Birmingham ,  they  are  well  below  those  for  the  other  American  cities 
in  this  group. " 

Mr.  Newton.  Is  it  your  purpose  to  insert  that  brief  in  the  record? 

Dr.  Baker.  I  should  be  glad  to  leave  the  whole  brief.  This  is  an  abstract;  this  is 
not  the  original  article  that  I  am  putting  in  the  record;  it  is  an  abstract.  However, 
I  should  be  very  glad  to  leave  the  original  article. 

(See  pamphlet  "The  Real  Risk — Rate  of  Death  to  Mothers  froni  Causes  Connected 
^\T.th  Childbirth,  by  William  Travis  Howard,  jr.,  reprinted  from  American  Journal 
of  Hygiene,  vol.  I.,  No.  2,  Mar.  1,  1921). 

Mr.  Mapes.  Dr.  Baker^  how  are  the  statistics  "sou  are  giving  taken?  Does  the 
authority  you  quote  base  his  calculation  upon  the  per  capita  population  of  the  different 
countries? 

Dr.  Baker.  This  is  based  on  the  entire  number  of  births  occurring  in  a  city,  and  the 
rates  are  usuallj^  per  10,000  births,  in  order  to  have  an  index. 

Mr.  Mapes.  And  the  figures  are  not  based  on  the  per  capita  population  at  all? 

Dr.  Baker.  No;  they  are  based  entirely  upon  the  number  of  births  in  the  different 
countries.  The  maternal  mortality  rates  are  iisually  computed  on  the  number  of 
labors,  so  called,  the  number  of  confinements  that  have  taken  place  or  the  number  of 
children  born,  because  they  do  not  affect  the  entire  population.  For  instance,  it 
would  not  be  fair  to  take  the  maternal  mortality  rate  in  a  mining  town,  where  there 
were  very  few  women,  and  base  it  on  the  whole  population  of  the  town,  and  then 
compare  it  with  the  maternal  mortality  rate  in  some  town  where  women  were  greatly  in 
excess  and  base  it  upon  the  whole  population  of  the  town.  Therefore,  it  is  based  upon 
the  number  of  actual  births  that  occur,  which  obviates  any  discrepancy.  So  those 
figiu'es  are  exactly  on  the  same  basis  for  all  the  different  places.  They  are  based  on  the 
same  factors. 

Mr.  GjiAHAM.  Do  you  know  whether  these  figures  are  controverted  by  anyone  or 
disputed? 

Dr.  Baker.  They  are  not  disputed:  they  are  the  official  figures  given  out  by  the 
different  cities  and  by  the  United  States  Census  Bureau. 

Mr.  Graham.  The  figures  you  are  citing  now  are  simply  figures  as  to  the  deaths  of 
mothers.     Have  you  gone  into  the  infant  mortality  proposition? 
"  Dr.  Baker.  Not  yet. 

Mr.  Graham.  In  this  report,  with  which  you  are  doubtless  familiar,  how  do  the 
various  large  cities  of  the  United  States  compare?  I  think  you  have  cited  a  few  of 
them,  but,  for  instance,  take  different  localities  in  the  country.  Is  there  any  apparent 
discrepancy  between  the  figures  outside  of  the  city  of  New  York? 

Dr.  Baker.  The  difficulty  in  answering  that  que.stion  is  the  fact  that  practically  all 
the  cities  are  extremely  negligent  in  regard  to  their  birth  registration,  and  I  am  sure 
you  would  not  care  to  have  me  quote  figures  from  the  majority  of  the  cities  in  the 
United  States,  because  they  are  inaccurate. 

Mr.  Graham.  Take  the  city  of  Philadelphia  and  the  city  of  New  Orleans.  Can  you 
draw  any  comparison  between  them? 

Dr.  Baker.  No;  because  the  city  of  Philadelphia  has  accurate  birth  registration, 
according  to  the  Census  Bureau,  and  is  included  in  the  birth-registration  area,  whereas 
the  city  of  New  Orleans  is  not,  and  it  is  not  probable  that  any  large  number  of  their 
births  are  actually  registered  down  there,  so  that  any  conclusion  drawn  from  their 
statistics  would  not  he  dependable  at  all. 

Mr.  Graham.  The  figures  you  give,  or  that  this  author  gives,  are  entirely  urban; 
that  is,  they  are  city  figures,  and  there  is  no  rural  population  included. 

Dr.  I3aker.  I  have  not  attempted  to  quote  from  the  whole  article,  but  I  may  say 
that  in  it,  without  attempting  to  quote  his  words,  he  makes  a  very  broad  comparison 
between  the  entire  United  States  registration  area,  which  at  the  present  time,  1  think, 
consists  of  about  26  States,  where  the  birth  registration  is  supposed  to  be  fairly  accurate. 
He  compares  this  with  European  countries  and  draws  the  conclusions  which  I  speak  of, 
that  the  maternal  mortality  rate  in  this  country,  as  a  whole,  is  about  120  per  cent  higher 
than  it  is  in  England,  for  instance.  In  determining  that  percentage  he  uses  the  best 
available  statistics  which  the  Census  Bureau  is  able  to  give,  and  those  statistics  are  the 
only  ones  they  are  willing  to  state  are  at  all  correct  for  those  26  States. 


PUBLIC   PUOTECrnON    OF    i\iATERNlTY   AND   INFANCY.  11 

Mr.  Cooper.  In  answer  to  the  question  Mr.  Graham  asked  you  a  moment  af^o,  1 
believe  it  was  stated  before  our  committee  at  the  last  hesinng  on  this  Vjill  that  the 
death  rate  in  the  rural  distrirts,  in  a  majority  of  cases,  was  f;;reater  than  it  was  in  the 
lar<?er  cities^  like  New  York. 

Dr.  Baker.  Well,  in  comparison  with  New  York,  I  have  no  doubt  the  maternal 
death  rates  are  higher  in  rural  districts  because  the  death  rate  in  New  York,  as  I  have 
just  said,  is  cons[)icuously  low.  It  is  lower  than  any  of  the  other  bi<i;  cities  in  this 
country  and  from  ])revental)le  causes  is  lower  than  any  of  the  bi<^  cities  in  Europe. 
Conseriuently,  to  com])are  us  with  a  rural  community,  where  no  work  has  been  done, 
would  probably  react  most  disadvantageously  to  the  rural  community.  I  have 
no  doubt  about  that,  but  1  have  no  figures — possibly  some  of  the  other  speakers  may 
have — whicii  I  am  willing  to  quote  to  prove  that  the  maternal  death  rate  is  higher  in 
rural  communities  than  in  cities.  I  do  not  want  to  be  understood  as  saying  that  there 
are  not  such  figures  and  that  they  can  not  be  presented  to  this  committee. 

Mr.  Cooper.  If  you  will  pardon  me,  I  believe  that  was  the  contention  made  by 
reason  of  this  work  not  being  done  in  the  riu-al  districts  like  it  was  in  the  larger  cities; 
that  tliat  was  the  reason  the  death  rate  was  much  greater  than  it  is  in  the  cities,  and 
that  was  one  argument  they  presented  for  this  bill,  that  the  people  in  the  rural  dis- 
tricts could  not  get  nurses  or  physicians  at  the  proper  time. 

Dr.  Baker.  I  have  an  idea  that  the  figures  of  the  United  States  Census  Bureau 
would  show  that  very  clearly,  and  that  those  figures  are  available  I  have  no  doubt. 
Judge  Towner  may  get  one  of  the  subsequent  speakers  to  present  those  figures  to 
you.     I  simply  do  not  hapx)en  to  have  them. 

Mr.  Merritt.  I  am  asking  this  for  information  only.  Would  not  the  fact  that 
birth  statistics  are  not  well  kept  in  this  counjtry  tend  to  show  a  higher  ratio  here  for 
the  reason  that  a  baby  when  born  may  not  be  registered,  but  when  it  dies  it  is 
registered? 

Dr.  Baker.  That,  of  course,  is  perfectly  true,  but  the  birth  registration  figures  we 
are  quoting  and  using  in  all  of  our  studies  are  taken  only  from  those  places  that  are 
said  by  the  United  States  Census  Bureau  to  have  a  birth  registration  of  over  95  per 
cent.  So  we  are  not  attempting  to  use  birth  registration  figures  from  any  questionable 
source. 

Mr.  Lea.  I  understood  you  to  say  that  the  cause  of  the  greater  death  rate  are 
ignorance  and  poverty,  that  they  are  the  two  principal  causes.  Is  the  greater  death 
rate  in  America  due  to  ignorance  and  poverty  or  to  other  causes? 

Dr.  Baker.  It  depends  entirely  upon  what  you  mean  by  ignorance  and  poverty. 
I  should  say  that  the  main  causes  of  the  maternal  death  rate  were  lack  of  proper 
instruction  during  the  prenatal  period  and  proper  medical  care.  The  main  causes 
of  infant  mortality  I  would  sum  up  as  being  social  and  economic,  that  is,  wrong 
environment  both  social  and  economic,  and  finally,  to  a  lesser  extent,  what  we  might 
call  lack  of  medical  attention.  An  infant  always  dies  from  some  disease,  but  the 
thing  which  causes  the  disease  is  usually  some  bad  en\ironmental  condition. 

Mr.  Towner.  Won't  you  please  state  to  the  committee  the  reason  why  the  mor- 
tality rate  in  New  York  City  in  these  cases  has  decreased?  I  think  the  committee 
would  be  anxious  to  know  how  you  have  been  able  to  so  notably  reduce  the  mortality 
rate  in  New  Y^ork. 

Dr.  Baker.  Well,  we  ascribe  that  to  several  causes.  First  of  all,  the  better  educa- 
tion of  the  mothers  as  to  the  care  of  themselves  during  the  pregnant  period.  We  have 
found  by  intensive  work — and  it  is  so  found  wherever  it  has  been  tried — that  you  can 
instruct  a  mother  during  her  pregnant  period  as  to  the  simple  means  by  which  she 
can  care  for  herself  during  that  time,  and  in  that  way  you  can  reduce  the  maternal 
death  rate  at  least  one-half  and  in  many  instances  two-thirds.  We  have  also  found 
that  these  women  give  birth  to  healthier  babies  and  that  the  baby  death  rate  in  the 
first  month  of  life,  among  that  group  of  women  who  have  had  this  prenatal  super- 
vision, is  also  reduced  at  least  one-half  and  sometimes  two-thirds.  We  have  had  in 
New  Y'ork  for  a  number  of  years  a  well  organized  control  of  maternal  work.  By  that 
I  mean  we  have  had  the  cooperation  of  the  obstetricians,  of  the  lying-in  hospitals, 
and  we  have  had  very  good  control  of  our  midwives,  so  that  we  have  attempted  to 
give,  and  I  believe  we  have  l)een  successful  in  gi^'ing.  to  the  mothers  there  a  foiTn  of 
maternal  care  at  the  time  of  childbirth  that  has  made  it  reasonably  safe,  at  least — 
and  safer  than  in  any  of  the  other  large  cities — for  them  to  give  birth  to  their  children. 

Mr.  Towner.  Will  you  please  tell  the  committee  how  this  work  is  done,  whether 
it  is  forced  upon  them,  whether  or  not  it  is  against  their  will,  and  how  it  is  received. 

Dr.  Baker.  I  have  been  talking  entirely  upon  the  maternal  mortality  rate,  as  I 
started  on  that,  but  I  want  to  say  something  on  the  infant  death  rate.  too.  But  I  may 
say  in  this  connection  that  as  far  as  all  of  our  work  for  children  is  concerned,  the 
maternal  work,  the  work  for  babies,  and  work  for  the  older  children,  it  is  not  only 


12  PUBLIC   PEOTECTIOjST   of    MATEElSriTY   AISTD  Il^FAl^CY. 

■welcomed  but  it  is  eagerly  sought  for  by  the  people.  We  have  an  almost  impossible 
situation  because  we  can  not  take  care  of  all  of  the  mothers  and  babies  that  want  care 
and  need  it.  I  may  also  say  that  we  have  splendid  cooperation  on  the  part  of  the  med- 
ical profession.  I  have  heard  it  said  that  one  of  the  reasons  for  opposition  to  this  bill 
is  that  the  doctors  are  opposed  to  it  on  the  ground  that  it  would  interfere  with  their 
practice. 

I  hold  no  brief  for  the  medical  profession,  bat  because  I  am  a  member  of  it  I  am 
extremely  sorry  to  have  anything  of  that  sort  said  about  any  doctors.  I  do  not  believe 
it  is  so,  because  the  doctors  of  New  York  have  been  loyally  with  us;  they  have  bene 
interested  in  the  work,  have  been  helpful  and  are  anxious  to  have  it  continued.  Some 
few  years  ago,  when  there  was  a  possibility  of  the  work  being  given  up  owing  to  a 
change  of  administration,  the  medical  societies  of  the  city,  the  Academy  of  Medicine, 
the  five  county  medical  societies,  and  a  number  of  the  small  group  of  medical  socie- 
ties, had  meetings  and  I  believe  for  the  first  time  in  their  entire  careers  passed  resolu- 
tions saying  they  wanted  the  work  continued,  that  there  should  not  be  any  idea  of 
giving  up  the  children's  work  in  the  city  because  they  considered  it  so  valuable. 
The  women  themselves  came  forward  and  I  had  great  difficulty  in  stopping  two 
parades  of  about  5,000  women,  one  from  the  East  Side  and  one  from  Brooklyn.  They 
wanted  to  march  to  the  City  Hall  and  protest  against  the  gi'v'ing  up  of  the  baby  health 
stations  and  the  visiting  niu-ses.  The  work  is  never  brought  to  them  in  any  way  that 
has  any  compulsion  about  it.  The  women  usually  come  to  us,  we  do  not  go  to  them, 
and  if  we  do  it  is  always  understood  that  they  want  it.  My  own  personal  feelings  is, 
of  course,  that  any  home  is  quite  as  sacred  to  the  inhabitant  of  it  as  any  other  home, 
and  no  nurse  and  no  doctor  are  allowed  to  go  to  any  house,  any  tenement  or  any  apart- 
ment without  the  full  willingness  and  invitation  of  the  people  who  live  there.  But 
these  people  want  our  help;  they  are  anxious  for  it;  they  are  asking  for  it  and  want 
it  in  far  greater  measure  than  we  are  able  to  give  it  to  them.  So  we  have  not  had  any 
opposition  from  the  medical  profession  and  we  have  not  had  any  opposition  from  the 
public.  I  think  that  New  York  people,  after  all,  are  not  so  different  from  other 
people,  and  as  far  as  I  know,  wherever  this  work  has  been  tried,  the  women  have  been 
very  glad  indeed  to  get  it.  I  know  of  no  woman  who  wants  her  baby  to  die  and  I 
never  met  any  difficulty  in  doing  something  which  would  save  her  baby,  and  I  want 
to  say  that  during  the  years  we  have  worked  in  New  York  City  we  have  reduced  our 
baby  death  rate  from  144  baby  deaths  out  of  every  1,000  births  to  85  deaths. 

Mr.  Denison.  Do  you  mean  1,000  births  or  10,000  births? 

Dr.  Baker.  One  thousand.  In  New  York,  where  we  have  carried  on  this  work,  out 
of  every  1,000  babies  born  144  died  in  the  first  year,  but  last  year  85  died  in  the  first 
year.  That  is  a  reduction  of  something  over  40  per  cent  and  it  means  an  actual  numer- 
ical reduction  of  about  7,000  lives  last  year.  In  other  words,  although  the  city  has 
grown  enormously,  we  actually  had  7,000  fewer  baby  deaths  last  year  than  we  had  12 
years  ago.  If  the  death  rate  of  12  years  ago  had  kept  up  there  would  have  been  in 
New  York  City  72,000  more  baby  deaths  in  those  12  years,  and  there  are  actually 
72,000  children  living  there  that  would  not  have  been  li\'ing  if  this  work  had  not  been 
done.  A  perfectly  logical  question — and  I  wish  some  one  had  asked  me,  Imt  I  am 
going  to  answer  it  any  way — is  this:  Is  this  just  simply  the  survival  of  the  fittest,  or  is 
it  just  the  tiding  over  of  these  babies  for  one  year,  and  then  do  we  lose  them?  We 
have  kept  in  very  close  contact  with  the  reduction  in  our  death  rate  between  1  and  5 
and  between  5  and  10,  and  we  have  reasona])ly  authentic  statistics  on  hand  to  show 
that  the  death  rate  between  1  and  5  and  5  and  10  has  been  reduced  more  than  the  death 
rate  under  1.  So  that  the  babies  are  not  only  alive  but  they  are  better  able  to  combat 
the  diseases  that  are  incident  to  child  life.  I  am  informed  that  it  has  been  computed 
by  the  actuaries  of  some  of  our  big  life  insurance  companies  and  the  actuary  of  our 
health  department  that  the  expectation  of  life  in  New  York  City  as  a  whole  has  been 
increased  five  years  because  of  the  work  that  has  been  done  in  reducing  the  infant  and 
child  mortality  rate  during  the  last  10  years. 

Mr.  Barkley.  Doctor,  you  stated  that  prior  to  the  inauguration  of  this  work  in  New 
York,  the  death  rate  among  children  was  144  per  ],000. 

Dr.  Baker.  Per  1,000  births. 

Mr.  Barkley.  Under  1  year  of  age. 

Dr.  Baker.  Under  1  year;  yes,  sir. 

Mr.  Barkley.  Of  course,  I  accept  those  figures  as  being  correct,  but  upon  what  do 
you  base  those  statistics? 

Dr.  Baker.  Those  are  the  vital  statistics  of  children  kept  by  the  official  registrar 
of  the  city. 

Mr.  Barkley.  Then,  there  can  be  no  mistake  as  to  their  accuracy. 

Dr.  Baker.  Absolutely  not. 

Mr.  Barkley.  They  sound  very  large  to  a  layman. 

Dr.  Baker.  They  are  true. 


pi'ulk!  I'iiori'ici'iox  ()!■'  .ma'ii'Jjm'i'y  and  inkaxcy.  13 

Mr.  BAUKMiY.  I  cl<)  not.  doiiht.  thai. 

Dr.  Uakkh.  1  am  ])erfe('tly  \villiiig  t(i  have  that  part  of  it  investigated.  They  are 
jii^<t  as  accurate  as  any  vital  statistics  are.     1  hold  no  brief  for  vital  statisticn. 

Mr.  ]{ahki,ky.  I  did  not  doubt  your  statement,  but  I  wanted  the  record  to.^how  the 
l)asin  for  it. 

Dr.  Bakkk.  The  actual  number  of  deaths  that  occurred  that  year  ba,sed  upon  the 
number  of  birth.s  that  occurred  that  year  showed  a  death  rate  of  144  per  1,000,  and 
dui;ins;  that  time  we  were  in  the  l)irth  registration  area  with  pre.sumal)ly  an  accurate 
l)irth  registration. 

Mr.  Newton.  Was  this  an  exceptional  year? 

Dr.  Baker.  Oh,  no. 

Mr.  Newton.  Or  was  that  the  average  for  that  period  and  the  period  preceding? 

Dr.  Baker.  It  was  the  average  for  that  year  and  the  year  preceding.  I  may  say 
that  this  year,  numerically,  outside  of  anything  else,  we  have  had  1,500  fewer  baby 
deaths  under  1  year  of  age  than  for  the  same  period  last  year.  Our  record  this  year 
is  evidently  going  to  be  from  20  to  24  points  below  last  year. 

Mr.  HuDDLE.'!TON.  May  I  ask  what  the  death  rate  was  between  1  and  2  years  of  age? 

Dr.  Baker.  I  should  like  to  give  that  information  to  you,  but  I  am  sorry  I  have 
not  those  figures  with  me.  I  -will  gladly  send  them  in  for  the  purpose  of  the  record 
if  you  would  like  to  have  them.  Infant  mortality,  as  we  keep  it,  is  considered  under 
1  year  of  age.  Between  1  and  5  years  of  age,  the  rate  has  fallen  more,  as  I  have  said, 
than  it  has  under  1  year  of  age. 

The  Chairman.  .ludge  Towner,  under  our  arrangement,  the  hearing  now  automat- 
ically ends  for  this  morning,  to  be  taken  up  again  at  10  o'clock  to-morrow  morning. 

(The  committee  thereupon  adjourned  until  Wednesday,  July  13,  192],  at  10  o'clock 
a.  m.). 


Committee  on  Interstate  and  Foreign  Commerce, 

House  op  Representatives, 

Wednesday  July  13,  1921. 
The  committee  met  at  10  o'clock  a,  m.,  Hon.  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

STATEMENT  OF  DR.  S.  JOSEPHINE  BAKER— Resumed. 

Dr.  Baker.  Mr.  Chairman  and  members  of  the  committee,  I  do  not  want  to  take 
much  of  your  time  this  morning  and  it  is  a  little  bit  difficult  to  know  where  to  begin, 
but  perhaps  I  can  best  do  so  by  saying  that  my  object  yesterday  in  calling  attention 
to  the  reduction  in  the  maternal  and  infant  death  rate  in  New  York  City  was  merely 
to  show  what  might  be  done  throughout  the  United  States  if  the  same  methods  were 
applied. 

The  Sheppard-Towner  bill  advocates,  as  I  read  it,  the  exact  type  of  work  that  we 
have  been  carrying  on  in  New  York  and  which  is  responsible  for  this  enormous  re- 
duction in  the  maternal  and  infant  death  rate.  It  consists  of  the  employment  of 
trained  nurses,  the  establishment  of  baby  health  stations  or  child  welfare  centers, 
and  the  employment  of  physicians  for  consultation  work.  The  work  is  mainly  edu- 
cational; it  is  almost  entirely  preventive.  The  women  come  to  us  early  in  their 
period  of  pregnancy  and  are  taught  how  to  care  take  of  themselves.  We  do  not  take 
care  of  actual  sick  cases  at  all;  we  teach  personal  hygiene  with  the  largest  adaptation 
possible  of  the  proper  environments,  and  mitigate  as  far  as  we  can  the  social  and  eco- 
nomic maladjustments  that  so  often  cause  ill  health.  We  can  do  a  good  deal  to  change 
the  effect  of  bad  enAaronmental  conditions. 

I  remember  when  this  work  ])eoan  in  New  York  City.  12  years  ago.  the  average 
luimber  of  baby  deaths  during  .July  and  August  would  range  from  1,000  to  1,500 
babies  a  week.  For  the  last  5  years  the  average  has  been  from  250  to  300  ])abies  a 
week  dying  during  those  same  months.  The  weather  can  not  be  chantred,  but  the 
effects  of  the  weather  may  be  changed,  and  while  it  may  not  be  i)ossible  to  change 
the  big  economic  problems  that  confront  the  big  ])art  of  otu'  population,  we  can  easily 
change  the  reaction  of  the  ])eople  to  these  conditions.  That  is  a  large  part  of  our  work — 
I  have  heard  this  bill  called  socialistic,  for  instance;  but  my  feeling  toward  it  is  it 
is  not  a  Socialist,  it  is  not  a  Republican,  and  it  is  not  a  Democratic  bill;  sim])ly  a 
human  bill — a  bill  of  the  finest  motives  of  any  I  have  ever  known  to  be  introduced. 

^Ir.  ("ooper.  Is  your  work  you  are  doing  in  New  York  classed  as  socialistic? 

Dr.  I'akkr.  Not  there;  no,  indeed.     No  one  ever  thinks  of  referring  to  it  as  that. 


14  PUBLIC   PROTECTIOlSr   OF   MATEEISTITY  AND  INFANCY. 

The  second  point  I  wanted  to  call  attention  to,  which  is  in  line  with  that,  is  that  in 
New  York  City,  which,  you  all  know  as  well  as  I  do,  we  probably  have  as  great  prob- 
lems as  can  be  found  anywhere  in  the  United  States.  I  have  personallybeen  able 
to  count  up  to  27  race  groups  or  partial  race  groups  with  which  we  have  to  deal.  I 
believe  81  per  cent  of  the  total  population  of  New  York  City  is  of  foreign  parentage. 
I  believe  the  Federation  of  Churches  says  there  are  68  race  groups  in  New  York  City. 
We  are  the  biggest  port  of  entry  in  the  United  States.  I  believe  80  per  cent  of  the  total 
immigration  comes  in  through  the  port  of  New  York.  We  have  problems  greater, 
possibly,  of  the  same  kind,  and  certainly  greater  in  kind  than  those  faced  by  other 
parts  of  the  country;  and  if,  with  the  most  congested  part  of  the  United  States  within 
our  borders,  with  this  huge  population  with  whatever  poverty  and  social  evils  may  exist 
there,  we  are  able  to  make  New  York  City  an  almost  perfectly  safe  place  for  a  baby 
to  be  born  in  and  to  grow  up  in,  it  would  seem  that  advantage  might  be  taken  of  our 
methods  by  the  rest  of  the  country,  because  the  problems  are  so  much  the  same,  and 
the  methods  we  are  using  will  undoubtedly  bring  down  the  maternal  and  baby  death 
rate  whenever  or  wherever  they  are  applied  in  the  rest  of  the  country. 

One  hesitates  to  refer  to  the  war  nowadays  but  sometimes  using  analogous  figures 
is  a  rather  good  thing.  During  the  18  months  we  were  at  war,  according  to  the  official 
figures  issued  by  the  Government,  there  were  some  37,000  or  38,000  men — somewhere 
around  that  number — actually  killed  in  action  or  who  died  as  a  result  of  wounds  re- 
ceived in  action.  During  that  same  18  months'  period  300,000  babies  under  1  year 
of  age  died  in  the  United  States,  and  we  know,  without  any  equivocation  whatever, 
that  with  the  use  of  the  methods  advocated  in  this  bill  at  least  a  half  of  those  lilies 
could  have  been  saved.  Worked  out  in  terms  of  figures,  one  can  say  it  was  eight 
times  safer  to  be  a  soldier  in  the  trenches  in  the  greatest  war  of  all  history  than  it  was 
to  be  a  baby  in  the  cradle  in  the  United  States.  During  that  same  18  months  for 
every  soldier  killed  in  action  or  who  died  as  a  result  of  wounds  received  in  action, 
one  mother  died  of  childbirth  in  the  United  States — the  numbers  are  almost  identical. 

The  Chairman.  While  you  are  on  that  point,  for  the  purpose  of  saving  time,  do  you 
happen  to  have  at  hand  any  statistics  showing  the  death  rate  in  different  portions  of 
the  country  in  the  United  State?,  whether  by  zones  or  any  other  geographical  limits? 

Dr.  Baker.  I  have  here  the  infant  mortalitv  rates  and  birth  registration  rates  for 
1919  for  some  26  States. 

The  Chairman.  But  not  by  any  group  or  section? 

Dr.  Baker.  No;  not  by  any  group  or  section,  simply  by  States.  And  I  have  here 
the  maternal  rates  by  States. 

The  Chairman.  Are  those  enumerated  by  States? 

Dr.  Baker.  By  States;  yes,  sir. 

The  Chairman.  Would  you  mind  passing  them  up? 

(The  statistics  were  handed  to  the  chairman.) 

Mr.  Graham.  I  have  always  been  under  the  impression  that  wars  produced  an  in- 
creased infant  mortality.     Was  that  true  during  this  war? 

Dr.  Baker.  It  was  true  in  some  of  the  regions  where  the  hardship  was  very  great 
indeed,  in  the  devastated  regions  in  northern  France  and  Serbia — I  do  not  know 
how  far  it  was  true  in  the  central  countries  of  Europe.  In  Belgium,  due  to  the  fact 
that  American  money  was  spent  there  in  such  quantities,  the  infant  mortality  rate 
actually  decreased  instead  of  increased,  and  it  also  decreased  in  England  during 
the  period  of  the  war  instead  of  increased,  due  to  the  action  of  the  English  Government 
in  taking  very  active  measures  to  combat  infant  mortality. 

Mr.  Graham.  What  was  the  case  in  the  United  States?" 

Dr.  Baker.  In  the  United  States,  the  infant  mortality,  I  should  say,  generally 
speaking,  did  not  definitely  show  the  effects  of  the  war.  The  undernourishment  of 
children  apparently,  particularly  the  child  of  school  age,  showed  a  distinct  reaction 
due  to  the  higher  prices  and  changed  conditions;  but  the  infant  mortality  I  think 
was  very  little  affected  by  the  war.  We  had  a  lower  birth  rate,  just  as  all  countries 
did,  due  to  the  absence  of  men  of  marriageable  age  in  such  large  numbers. 

Mr.  Graham.  I  have  another  thing  in  my  mind:  Did  Germany,  prior  to  the  war, 
have  a  system  somewhat  similar  to  the  system  outlined  in  this  bill;  that  is,  a  method 
of  supervision  of  births  and  assistance  in  the  ways  that  are  indicated  by  this  bill? 

Dr.  Baker.  Germany  had,  previous  to  the  war,  a  very  fairly  efficient  system  of 
child  hygiene  work  and  it  was,  I  understand,  supported  by  the  general  government, 
although  the  localities,  I  think,  contributed  also  to  its  support.  There  is  hardly  a 
country  in  Europe  to-day  that  has  not  a  good  system  for  the  care  of  the  health  of  chil- 
dren; it  would  be  difficult  to  find  one  that  has  not  been  doing  very  extensive  work. 

Mr.  Graham.  The  reason  I  alluded  to  Germany  was  I  had  been  advised  that  their 
system  was  better  and  their  infant  mortality  had  been  very  greatly  reduced. 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  15 

Mr.  Baker.  I  can  not  answer  as  to  the  infant  mortal  ty  of  Germany  as  a  whole, 
because  it  has  been  impossible  to  get  the  fgiires  there  for  a  long  time;  but  the  last 
date  for  wliich  I  was  al)le  to  got  the  death  rate  for  Herlin,  which  was  just  as  tlie  war 
began,  showcnl  that  tlie  infant  death  rate  at  that  time  was  160  infant  deaths  out  of 
every  thousand  births,  and  that  is  so  high  that  we  have  hardly  anything  to  match  it 
any  place  in  this  country. 

Mr.  Mehkitt.   Is  that  the  result  of  the  German  system? 

Dr.  Baker.  It  is  the  result  of  their  attitude  toward  their  system  I  tliink  the 
saving  of  babies  is  distinctly  a  (juestion  of  the  right  attitude.  We  should  have  the 
attitude  toward  it  that  I  heard  Mr.  Ifolmer  Folkes  take  at  a  baby  show  in  Philadelj)hia. 
I  went  down  to  speak  at  wliat  was  called  a  baby-saving  show.  Mr.  Folkes  was  there, 
and  said  he  luid  come  down  to  speak  because  it  was  a  "baby-saving  show,"  and  not  an 
"infant  welfare  exhibit";  he  said  he  did  not  know  a  man  who  was  interested  in  an 
"infant-mortality  exhibit",  but  he  also  did  not  know  of  any  man  who  would  not 
go  out  to  save  a  baby  if  he  had  an  opportunity.  And,  after  all,  if  this  were  called  a 
baby-saving  bill,  1  think  it  might  make  a  greater  human  appeal. 

Mr.  Graham.  I  would  like  to  hear  you  discuss  something  about  what  divisions  of 
the  Federal  Government  would  cooperate  in  this  work  or  assume  some  part  of  the 
duties  connected  with  it;  whether  it  is  advisable  to  have  the  system  you  are  practicing 
now  in  New  York  or  to  vary  from  it?     I  would  like  to  hear  you  about  that. 

Dr.  Baker.  Of  course,  in  the  first  place,  I  want  to  say  even  if  this  bill  is  passed 
New  York  City  will  not  derive  one  cent  from  it  in  any  way.  Our  health  department 
is  entirely  separate  from  the  health  department  of  the  State,  so  that  we  would  not 
receive  any  money  from  this  bill  if  it  should  be  passed.  We  will,  however,  make  a 
very  large  contribution  toward  this  work  in  the  other  States.  When  it  comes  to  the 
whole  question  of  how  far  the  Federal  Government  can  go  or  should  go  in  stimulating 
States  to  do  work  th^  might  reasonably  initiate  themselves,  it  seems  to  me  we  are 
touching  on  a  question  very  much  more  fundamental  than  the  object  of  this  bill. 
It  seems  to  me  that  this  is  no  different  in  principle  from  legislation  for  helping  the 
State  dii'ectly  or  helping  to  stimiilate  the  State  to  do  work  within  its  own  borders. 
The  reason  I  advocate  the  Federal  Government  taking  up  this  particular  work  at  this 
time  is  because  in  every  other  country,  where  they  have  tried  to  work  out  any  plan  for 
the  reduction  of  the  baby  and  maternal  death  rates,  they  have  found  the  communi- 
ties themselves  were  notoriously  slow  and  had  to  be  stimulated  to  do  it  through  some 
Government  interest.  I  am  absolutely  opposed  to  the  idea  of  the  Federal  Govern- 
ment going  into  the  States  to  do  any  work  itself  and  do  not  see  anything  in  this  bill 
which  contemplates  any  such  action.  From  the  total  appropriation  for  administra- 
tion, something  like  $30,000,  which  has. to  pay  for  all  administrative  expenses,  I 
imagine  the  Federal  Government  can  give  nothing  more  than  the  work  in  their  cen- 
tral office.  The  only  relation  the  Federal  Children's  Bureau  has  to  this  bill  is  the 
approval  of  the  plans  submitted  by  the  States.  Those  plans  have  to  be  submitted  to 
an  advisory  committee  consisting  of  the  Surgeon  General  of  the  Public  Health  Service, 
the  Chief  of  the  Bureau  of  Education  of  the  Department  of  the  Interior,  and  the 
Secretary  of  Labor.     If  I  am  not  mistaken,  those  are  the  members  of  that  committee. 

After  the  program  is  once  approved — and  I  assume  that  the  Federal  Government 
would  not  be  willing  to  give  out  any  money  without  having  something  to  say  regard- 
ing the  program  of  any  State — then  it  is  the  business  of  the  State  to  do  its  own  work. 
It  would  not  be  conceivable  or  possible  for  any  Federal  agents  to  go  about  and  visit 
families  in  the  States;  the  States  themselves  have  to  do  that  work;  and  while  it  is  not 
compulsory  for  any  State  to  take  advantage  of  this  bill,  I  think  its  enactment  would 
be  extremely  stimulating  to  some  of  the  Eastern  States,  where  they  are  doing  good 
work  as  it  is  now,  and  certainly  it  will  be  of  enormous  advantage  in  the  Middle  West- 
ern and  Western  States.  They  have  been  very  slow  indeed  about  appropriating 
money  for  such  work,  and  I  think  we  are  coming  to  the  time  now  where  it  is  becoming 
more  and  more  the  business  of  the  Federal  Government  to  remove  the  stigma  of  our 
high  maternal  and  infant  mortality  rates.  It  is  not  a  pleasant  thing  to  contemplate 
our  place  among  the  so-called  civilised  nations  of  the  world  and  to  see  that  we  are 
apparently  more  negligent  of  the  lives  of  the  babies  and  mothers  than  17  other  nations 
of  the  world.  I  know  these  figures  have  been  questioned,  but  I  have  yet  to  find 
anybody  who  has  disproved  them.  From  the  best  information  obtainable  I  believe 
these  statistics  are  accurate.  If  anybody  has  any  information  which  will  disprove 
those  figm-es,  I  am  sure  I  would  like  to  know  of  it,  and  I  am  pretty  sure  the  Federal 
Government  would. 

Mr.  Newton.  Have  you  those . figures  available  showing  the  comparison  of  those 
different  countries? 

Dr.  Baker.  Yes,  sir. 

Mr.  Newton.  Could  you  insert  them  with  your  remarks? 


16 


PUBLIC   PROTECTION    OF   MATEEZSTITY   AND  INFANCY. 


Dr.  Bakek.  I  will  offer  as  part  of  the  record  the  Eighth  Annual  Report  of  the  Chief 
of  the  Children's  Bureau  to  the  Secretary  of  Labor  for  1920. 

]\Ir.  Merritt.  You  do  not  want  to  insert  that  whole  report  in  the  middle  of  your 
remarks? 

Dr.  Baker.  No,  sir;  just  the  figures  pertaining  to  the  maternal  and  infant  mortality. 

(The  comparison  referred  to  appears  below  and  on  page  17:) 

MATERNAL  MORTALITY    RATES 
per  1000  births 

Laiesi  available  ^jiures  up  to  \3\7 


New  Zealand. 

Australia . 

Spain- 

IVance- 

En^laniand  Wales. 

Norwa.v_ 
Owedetr- 


n 

2 

± 

i3 

g 


.UNITED  STATES 

.  Scotland 
.  5wi"h:erlancL 

.Ireland 

,  Hundari^ 

,  Rnlana. 
' Tru55ia 

jrhe  Netherlands 
.iraljf 


The  United  States  lost  over  23,000  -women  in  1918  from  childbirth.    We  have  a  higher  maternal  deatt 
rate  than  any  other  of  the  principal  countries. — Children's  Bureau,  U.  S.  Department  of  Labor. 

The  Chairman.  Do  you  know  whether  or  not  the  authorities  are  cited  for  th( 
figures  presented  in  that  report? 

Dr.  Baker.  I  would  have  to  look  at  it  to  find  out,  but  it  is  a  Government  report 
and  the  figures  have  been  obtained,  apparently,  from  official  figures  of  the  varioui 
governments  listed.  I  have  never  been  able  to  find,  and  I  have  searched  rathe: 
diligently,  any  accurate  information  that  these  figures  are  not  what  they  purport  t 
be;  and,  although  people  will  say  they  are  not  so,  I  have  never  received  the  slightes 
evidence  they  are  not. 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY. 


17 


infAnT  nOf^TALITY  THERnOMCTLR. 

DEATHS  UMOEK  I  YEAR  OF  AGE  PER  1,000  BIRTHS 


Irelaivci . 


Suedciv . 


rlofwo-v 


MLWZEALAnO. 


300 


CkUe i, 


phlTED  STATES ^ 

Engla-tui  and  Wales  .  y 


/::\ 


zzs 


!2£. 


^ nu.w^aTY 


_CU«,5trl 


-Spav 
-Itolv 


/  Flula-n-A 

^ 5co'tlaivd. 

•^ (1etlieTlan.ds 


<^ Sio<.ti.eTLait.d. 

^ DcuTnarfc 


-du-sirallcu 


WitW  tke  fiM  «|Co.T  a^ter  blrtk,  tke  UivUcA  State* 
Us**    Kw,  10  o+ all  babUs    boT«..     It  raivk,*    tUuctr-tk. 
O-inoit^    iK€     principai,    cou-n-trits     oi   tke    uotLa.     tltto 
Zealand,  Loses    feweT   babUa    tka-n  ant^    otkcr  cou-ntri^. 
Rai«»    are    +ot  latest   auavlabU  v^eaf*  u.p  t»  IS18. 
CHILDRCN'S  bureau, U.&DERAKTH&NT  OF  LABOR. 


74654—21- 


18  PUBLIC   PEOTECTIOlSr   OF   MATEENITY  AND  INFANCY. 

The  Chairman.  I  was  not  raising  that  question;  I  was  wondering  whether  there 
was  any  citation  of  authority.  |y 

Dr.  Baker.  I  think  you  will  find  that  from  this  report.  Bl| 

Another  point  that  has  been  brought  up  in  regard  to  this  bill  is  the  proper  Govern- 
ment department  to  have  control  of  it.  Speaking  in  behalf  of  the  city  health  depart- 
ment of  New  York,  I  wish  to  say  we  are  on  record  and  strongly  on  record  in  favor  of 
some  sort  of  a  national  department  of  health  or  public  welfare.  We  believe  that  all 
the  public  health  agencies  of  the  Government  should  be  placed  under  one  head. 
Without  prejudice,  therefore,  to  our  position  in  this  matter,  we  favor  this  bill  and 
favor  its  administration  being  placed  in  the  Children's  Bureau  because,  by  legislative 
enactment  of  Congress,  the  Children's  Bureau  has  already  been  given  authority  to 
inquire  into  the  causes  of  infant  and  maternal  mortality,  and  it  has  done  work  in  the 
States  that  stands  out  as  being  the  best  work  of  the  kind  done  by  any  children's  bureau 
in  any  country  in  that  particular  line.  It  has  a  very  able  technical  staff  of  doctors 
who  are  entirely  competent  to  administer  this  bill,  and  we  see  no  reason  whatever  for 
any  assumption  that  the  Children's  Bureau  is  not  entirely  fitted  to  do  this  work. 

Mr.  Graham.  Just  a  question  right  along  that  line:  I  take  it  from  what  you  say, 
Doctor,  that  yoii  are  not  in  favor  of  any  Federal  interference  with  State  work  or  city 
work  such  as  you  are  doing,  and  that  the  object  of  this  bill  or  any  similar  legislation, 
is  to  standardize  the  work  and,  bjr  cooperation  with  the  Federal  Government,  to  estab- 
lish in  the  various  States  a  high  standard  of  work  which  may  be  uniformly  followed 
by  the  several  States  and  that  the  function  of  the  Federal  Governmenfis  largely 
advisory? 

Dr.  Baker.  Exactly;  almost  entirely. 

Mr.  Graham.  Now,  what  is  this  Children's  Bureau;  what  is  the  nature  of  its  work? 
I  know  in  a  general  way,  but  you  know  more  definitely  and  intimately.  What  has 
been  the  nature  of  the  work  of  the  Children's  Bvireau  up  to  this  time? 

Dr.  Baker.  Up  to  the  present  time  the  Children's  Bureau  has  been  collecting  a 
series  of  statistics  which  serve  as  a  very  remarkable  background  for  any  program  of 
this  nature ;  statistics  relating  to  the  causes  of  infant  and  maternal  mortality  in  various 
localities  in  the  United  States.  Then,  in  addition,  they  have  done  a  great  deal  of 
research  work  into  problems  connected  with  child  labor.  These  statistics,  which 
they  have  gathered  throughout  the  country,  have  proved  to  be  to  every  child-hygiene 
worker  the  most  valuable  type  of  research  we  have  ever  had  available.  They  have 
enabled  us  to  work  out  programs  which  have  been  extremely  effective,  having  indi- 
cated on  what  points  to  concentrate.  The  Children's  Bureau  publications  are  ac- 
cepted, I  believe,  everywhere  in  the  world  as  being  the  highest  of  research  work  with 
relation  to  the  problems  affecting  the  health  of  children  and  mothers.  I  think  prob- 
ably Miss  Ivathrop  has  told  you  that  this  time  they  are  carrying  out  what  seems  to  be 
an  administrative  program  in  Porto  Rico  and  they  have  done  a  great  deal  of  work  of 
a  consultation  nature  with  Czechoslovakia  and  some  of  the  European  nations  who 
haA^e  been  interested  in  the  very  fine  nature  of  the  reports  that  have  been  given  oiit 
here.  They  have  interested  themselves  in  this  problem  as  no  other  part  of  the 
National  Government  has;  there  is  no  one  else  who  has  ever  exhibited  even  a  selfish 
interest  in  it  until  recently. 

The  Chairman.  Will  you  pardon  me  an  interruption? 

Dr.  Baker.  Certainly. 

The  Chairman.  Do  you  happen  to  know  the  particular  functions  of  the  Children's 
Bureau  by  virtue  of  the  act  which  created  it? 

Dr.  Baker.  Yes,  sir.  To  investigate  into  and  report  upon — I  am  not  attenipting 
to  quote  it  verbatim — matters  connected  with  a  reduction  of  the  infant  and  maternal 
mortality  and  matters  connected  with  the  employment  of  children;  the  so-called 
child-labor  laws.  And  it  seems  to  me,  as  the  Children's  Bureau  was  created  by 
legislative  enactment,  that  it  is  perfectly  easy  by  legislative  enactment  to  increase 
or  decrease  their  powers  at  any  time. 

The  Chairman.  But  you  spoke  of  certain  administrative  work  they  are  now  doing; 
what  is  that? 

Dr.  Baker.  I  may  be  mistaken  in  that;  but  I  know  they  are  working  down  in 
Porto  Rico.  Whether  that  is  within  the  powers  of  the  bureau,  I  do  not  know;  but  I 
know  thay  are  working  down  there.  Just  at  the  present  time  it  seems  to  me  that  where 
our  rural  communities  generally  throughout  the  country  are  doing  practically  no 
work  of  this  kind,  where  mothers  in  many  instances  are  left  entirely  without  proper 
care  during  the  progress  of  confinement,  where  there  is  no  one  but  the  nearest  neigh- 
bor, who  may  be  10  or  20  miles  away,  to  come  in  and  help,  where  the  baby  death  rate, 
although  not  near  as  high  as  in  the  large  cities,  is  still  abnormally  high,  at  such  a  time 
as  this  it  seems  to  me  more  or  less  an  academic  question  to  discuss  whether  the  admin- 
istration of  this  bill  should  be  under  one  or  another  part  of  the  Federal  Government. 


1_ 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  19 

The  main  thing  we  are  intorcsted  in  is  to  hoo  that  it  is  put  into  effoft  as  (luir-kly  as  may 
be,  80  that  the  present  death  rate  of  mothers  and  l)ahies  in  this  country  shall  he 
reduced.  It  can  be  reduced.  This  bill  does  not  hold]  out  any  false  promise.  We 
can  reduce  this  d(^ath  rale  with  the  establishment  of  the  princi])]es  already  known. 
We  know  this  is  so  and  we  are  inclined  at  this  time  to. agree  with  Dr.  Holt's  statement 
that  it  is  not  the  unfit  l)aby  but  the  unfortunate  baby  that  dies.  With  an  expendi- 
ture for  the  entire  I'liited  States  of  a])proxima1ely  only  $500, 000  more  a  year  than  the 
city  of  New  York  is  now  s])ending  upon  its  own  children,  the  entin?  country  can  be 
covered  and  I  can  predict  with  reasonable  accuracy  that  you  will  find  what  has  been 
accomplished  in  New  York  City  can  be  accomplished  in  the  United  States. 

Mr.  Burroughs.  I  was  very  much  interested  in  hearing  you  tell  about  this  work  in 
New  York.  T^et  me  ask  you:  Is  that  work  done  under  the  jurisdiction  of  the  municipal 
public  health  department? 

Dr.  H.VKKR.  Yes,  sir;  it  is  paid  for  out  of  the  funds  derived  by  taxation  and  a])pro- 
])riated  in  the  city  budget  and  spent  liy  the  city  department  of  health. 

Mr.  lUruROx'dii.s.  Did  I  understand  you  to  say  the  work  had  been  going  on  for  al)out 
1 2  years? 

Dr.  Baker.  Yes,  sir. 

Mr.  BuRROdcHs.  Was  any  special  legislation  necessary  for  that  work  to  be  insti- 
tuted or  carried  on? 

Dr.  B.\KKR.  No,  sir.  Under  the  broad  legislative  and  charter  powers  of  the  board  of 
health  in  New  Y'ork  City,  the  l)oard  can  pass  resolutions  which  are  known  as  part  of  the 
sanitary  code.  If  the  board  of  health  wishes  to  enact  any  health  law  it  has  the  ])ower 
to  do  it  and  incorporate  it  in  the  sanitaiy  code,  and  thereupon  it  takes  the  force  of  law. 

Mr.  BuRROUfiiis.  Do  you  know  of  any  other  citieg  of  the  country  where  that  or 
similar  work  is  being  carried  on  at  the  present  time? 

Dr.  Baker.  Yes,  sir;  in  practically  all  of  the  large  cities  to  a  greater  or  lesser  degree 
some  work  for  the  reduction  of  infant  mortality  is  being  carried  on — Philadelphia, 
Chicago,  Boston,  Cleveland,  Detroit — in  fact,  I  can  hardly  mention  all  of  them — they 
are  all  doing  something  of  that  type  of  work  but  not  to  as  great  an  extent  as  New  York. 

Mr.  BuRROuc.HS.  For  the  reduction  of  the  infant  death  rate? 

Dr.  Baker.  Yes,  sir. 

Mr.  Graham.  Just  a  few  more  questions.  Do  you  think,  Doctor,  there  would  be  any 
material  change  in  the  work  that  your  bureau  is  conducting  if  this  bill  became  a  law? 

Dr.  Baker.  No,  sir;  it  would  not  affect  us  one  way  nor  the  other. 

Mr.  Graham.  It  is  your  idea,  then,  that  the  desirability  of  this  bill  becoming  a  law 
consists  in  the  fact  that  it  might  be  applied  to  communities  more  backward  and  where 
they  are  not  taking  the  forAvard  steps  you  are  now  taking  in  New  York  City? 

Dr.  Baker.  Yes,  sir. 

Mr.  Graham.  Have  you  some  one  here  who  will  tell  us  something  about  what  class 
of  peo])le  in  New  York  City  require  this  care  more  than  others,  or  can  you  tell  us  that? 
I  am  curious  to  know.  Is  it  the  so-called  foreign  element,  or  just  where  is  your  work 
most  needed? 

Dr.  Baker.  Naturally  enough,  in  New  York  City,  our  early  work  was  almost 
entirely  with  the  foreign  element.  They  seemed  more  anxious  to  get  this  kind  of  help 
than  the  native  people  did.  The  result  has  been  that  the  greater  part  of  the  reduction 
of  the  infant  death  rate  has  taken  place  in  the  foreign  group,  so  that  at  the  present  time 
our  highest  baby  death  rate  is  among  the  babies  of  native-born  parents.  That.  I 
believe,  may  not  be  true  of  many  other  cities.  Vv^e  recognize  no  difference  in  the 
groups  that  come  to  us.  All  of  the  groups,  including  the  native  born  and  all  of  the 
foreign  groups  receive  our  help.  We  have  done  a  great  deal  of  work  with  the  colored 
group,  for  instance,  where  the  death  rate  is  notoriously  high  and  where  we  have  been 
able  to  reduce  it  to  a  most  remarkable  degree.  Of  course  in  the  Southern  States  a  great 
proportion  of  the  deaths  are  in  the  colored  group.  We  have  about  60,000  babies  a  year 
under  our  care  in  New  York  City  and  each  baby  is  cared  for  individually. 

Mr.  Newtox.  You  mentioned  the  work  of  the  Children's  Bureau.  Now,  if  this 
work  is  to  be  carried  on  Ijy  the  Federal  Government  it  will  have  to  be  lodged,  of 
course,  in  some  bureau,  and  there  are  some  who  advocate  putting  it  into  the  Children's 
Bureau,  and  I  believe  there  are  some  who  advocate  placing  it  in  the  Public  Health 
Service.     Now.  you  are  familiar  with  the  work  of  the  Public  Health  Service,  of  course? 

Dr.  Baker.  I  am  a  surgeon  in  the  Reserve  Corps  and  also  a  consultant  in  child 
hygiene,  but  I  am  not  speaking  for  them  at  this  time. 

Mr.  Newton.  What  is  your  opinion  as  to  just  where  this  work  should  be  lodged, 
in  the  Children's  Bureau  or  the  Pulilic  Health  Service? 

Dr.  Baker.  I  have  already  expressed  the  opinion  that  the  Cluldren's  Bui-eau  is 

>  very  mucli  better  fitted  at  the  present  time  to  undertake  this  work.     This  is  said 

without  prejudice  to  its  reorganization  under  a  department  of  health.     Their  work  in 


20  PUBLIC   PEOTECTIOlSr    OF    MATERNITY   AND   HSTFANCY. 

the  past  and  tlieir  relation  with  the  various  groups  in  the  States  already  doing  some 
work  of  this  natiu-e,  in  my  opinion,  makes  them  far  better  fitted  for  the  administra- 
tion of  the  bill  than  the  Public  Health  Service,  but  I  want  to  be  distinctly  under- 
stood that  this  opinion  does  not  prejudice  my  conviction  that  all  those  activities 
should  come  together  and  be  under  one  control.  As  things  stand  now,  however,  I 
think  the  legislation  should  place  it  under  the  Children's  Bureau,  and  then,  with 
reorganization  of  all  health  activities  of  the  Government,  it  would  naturally  fall  into 
the  right  place. 

Mr.  Newton.  They  are  in  a  position  to  immediately  take  up  the  work? 

Dr.  Baker.  In  my  opinion. 

Mr.  Newtox.  But  the  ideal  method  would  be  to  have  it  all  lodged  in  one  Public 
Health  Service? 

Dr.  Baker.  Absolutely;  there  is  no  question  about  that. 

Mr.  Barkley.  Then,  assuming  there  would  be  such  a  reorganization,  there  need 
not  be  any  identity  of  the  work  between  the  Public  Health  Service  and  this  Children's 
Bureau,  assuming  they  are  all  put  under  one  department? 

Dr.  Baker.  Personally,  I  should  think  they  ought  to  be.  I  understand,  from 
looking  over  a  chart  prepared  by  Gen.  Sawyer,  that  he  has  placed  the  functions  of 
the  Children's  Bureau  in  what  he  calls  a  Di^dsion  of  Welfare,  while  in  an  entirely 
different  division  he  has  put  the  work  now  canied  on  by  the  Public  Health  Service, 
which  has  mainly  to  do  with  quarantine  and  control  of  infection,  and  apparently 
very  little  strictly  educational  work  has  been  carried  on.  That,  I  assume,  is  open 
to  change,  Ijut  at  the  present  time  these  two  types  of  work  have  been  placed  in 
separate  di\'isiolis. 

Mr.  Barkley.  The  Public  Health  Service  is  more  or  less  the  "medicated^'  function 
of  the  Government,  is  it  not?     [Laughter.] 

Dr.  Baker.  It  has  had  to  do  with  corrective  work  very  generally  in  the  past.  The 
greatest  part  of  its  functions,  as  I  understand  them,  have  consisted  in  the  mainte- 
nance of  quarantine,  particularly  with  reference  to  our  ports,  and  the  control  of 
diseases  of  an  infectious  nature.  I  do  not  think  it  has,  until  quite  recently,  con- 
cerned itself  very  much  about  these  questions  which  are  very  largely  social. 

Mr.  Barkley.  That  is  what  I  had  in  mind,  that  the  Children's  Bureau,  which  has 
made  a  special  study  of  child  life  and  which  brings  into  play  the  human  element 
and  social  element,  is  better  qualified  than  a  group  of  professional  medical  men  to 
consider  the  welfare  of  the  child  and  questions  of  child  hygiene  and  infant  and  ma- 
ternal mortality. 

"Dr.  Baker.  You  could  hardly  expect  me  to  say  that.  [Laughter.]  I  can  not 
assume  that  a  group  of  well-quaUfied  medical  people  could  not  administer  this  bill; 
nor  do  I  subscribe  to  the  assumption  that  the  Public  Health  Service  is  not  qualified. 
I  simply  wish  to  say,  in  the  past  they  have  almost  exclusively  devoted  themselves  to 
the  control  of  quarantine  and  infectuous  diseases;  and  while  I  believe  they  are,  with- 
out doubt,  qualified,  they  are  not  taking  up  and  are  not  doing  and  have  not  interested 
themselves,  so  far  as  I  know,  in  the  type  of  investigation  that  the  Children's  Bureau 
has  carried  on.  My  personal  and  official  opinion  is  the  Children's  Bureau  is  better 
qualified  at  the  present  moment  than  any  other  part  of  the  Federal  Government 
to  administer  this  bill. 

Mr.  Cooper.  You  spoke  a  moment  ago  of  some  chart  Brig.  Gen.  Sawyer  was  pre- 
paring.    What  chart  is  that? 

Dr.  Baker.  I  saw  an  article  in  one  of  the  monthly  magazines  in  which  he  gave  a 
full  outline  of  his  proposed  organization  of  the  new  department  of  public  welfare. 

Mr.  Cooper.  I  am  ignorant  about  the  general's  doings;  and  by  what  authority  is  he 
doing  that?     [Laughter.] 

Dr.  Baker.  I  do  not  know,  Mr.  Cooper. 

The  Chairman.  Will  you  kindly  describe  the  organization  of  your  New  York 
department? 

Dr.  Baker.  Of  the  children's  department? 

The  Chairman.  The  nature  of  its  organization — say  its  trustees  or  directors  or  what- 
ever the  organization  may  be. 

Dr.  Baker.  The  department  of  health  itself  is  one  of  the  organic  parts  of  the  city 
government  and  functions  under  charter  rules  and  regulations  giving  it  control  over 
all  matters  relating  to  the  health  of  the  city.  It  has  a  board  of  health  consisting  of 
the  health  officer  of  the  port,  the  police  commissioner,  and  the  commissioner  of  health. 
The  commissioner  of  health  is  president,  by  virtue  of  his  office.  He  is  Dr.  Roy»l 
Stone  Copeland. 

The  Chairman.  Who  are  the  other  members  of  the  board? 

Dr.  Baker.  The  police  commissioner,  Richard  Enright,  appomted  by  the  mayor, 
and  Dr.  Leland  Cofer,  who  is  the  health  officer  of  the  port.  Under  the  present  arrange- 
ment he  is  an  official  of  the  United  States  Public  Health  Service  detailed  to  that  duty. 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  21 

The  Chairman.  Two  of  the  three  members  are  physicians? 

Dr.  Baker.  Two  are  physicians  now. 

The  Chairman.  Two  out  of  three? 

Dr.  Baker.  I  do  not  know  whether  the  health  officer  of  the  port  has  to  be  a  physician 
or  not.     The  commissioner  of  health  does  not  have  to  be  a  physician. 

The  Chairman.  Now  go  on  through  them. 

Dr.  Baker.  Then  there  are  eight  bureaus  of  the  department  of  health.  They  have 
the  bureau  of  cliild  hygiene,  which  is  divided  into  certain  divisions.-  We  have, 
owing  to  our  curious  political  distiibution  of  territory  in  New  York,  five  boroughs 
and  we  find  it  necessary  to  have  a  borough  chief  in  charge  of  each  borough  and  each 
one  of  these  chiefs  has  a  number  of  supervising  inspectors  and  nurses  directly  respon- 
sible to  him.  Under  these  supervisors  are  placed  the  staff  of  doctors  and  nurses  who 
do  the  work  of  the  field. 

The  Chairman.  What  is  the  training  of  the  nurses  to  whom  you  refer;  are  they 
graduate  school  nurses? 

Dr.  Baker.  They  are  all  graduate  nurses  who  have  received  the  degree  of  R.  N. 
from  the  State  Board  of  Regents  of  New  York,  and  who  have  then  passed  a  civil- 
service  examination. 

The  Chairman.  And  you  are  at  the  head? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  And  so,  taking  yourself  into  consideration  and  all  the  field  agents, 
they  are  all  trained  graduate  nurses  registered  in  New  York  State? 

Dr.  Baker.  I  am  not  a  nurse.  The  field  nurses  all  are.  We  have  also  a  large  staff 
of  physicians. 

The  Chairman.  And  they  ai'e  registered  under  the  New  York  State  law? 

Dr.  Baker.  The  doctors  and  nurses  are,  yes,  sir.  Then  we  have,  of  course,  the 
necessary  clerical  staff,  various  types  of  what  we  call  nurses'  assistants,  and  then 
■tenographers. 

The  Chairman.  Do  they  go  into  the  field? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  The  assistants? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  But  under  the  direction  of  trained  nurses? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  Responsible  to  you  and  then  to  the  board  of  governors? 

Dr.  Baker.  Yes,  sir-.  The  functions  we  cover  include  prenatal  work,  the  reduction 
of  infant  mortality,  the  care  of  abandoned  and  illigetimate  babies;  we  have  control  of 
the  day  nurseries  and  orphan  asylums,  or  institutions  for  dependent  children,  the 
examination  of  all  children  of  preschool  age,  the  medical  inspection  of  all  children  in 
parochial  and  public  schools. 

The  Chairman.  What  class  of  people  do  that  inspection  work? 

Dr.  Baker.  Doctors  and  nui'sss.  Then  we  have  the  enforcement  of  the  child  labor 
law — that  part  of  it  which  pertains  to  the  health  of  the  children  and  the  issuance  of 
employment  ceitificates. 

The  Chairman.  That  is  not  done  by  nurses? 

Dr.  Baker.  The  jjhysician  examines  the  children;  it  is  done  by  doctors.  The  rest 
of  it  is  done  by  the  lay  staff.  The  work  of  the  Bureau  of  Child  Hygiene  follows  the 
child  through  fi'om  the  period  before  birth  right  up  through  the  period  of  adolescence, 
and  has  health  control,  generally  speaking,  of  the  larger  part  of  the  children  of  New 
York  City. 

The  Chairman.  Speaking  particularly  and  not  technically,  but  in  a  fair  sense,  can 
it  not  be  said  that  your  organization  is  strictly  a  medical  organization,  carried  on  by 
medical  people,  trained  under  medical  conditions,  and  the  examination  of  it  and 
opirit  of  its  thought  and  initiative  of  its  ideas  comes  from  medical  assistance? 

Dr.  Baker.  I  think,  in  order  to  answer  that  fairly,  that  I  should  have  to  say  it 
is  true  I  am  a  physician  and  that  my  staff  are  very  largely  physicians  and  nurses; 
but  that  the  work  of  the  reduction  of  infant  mortality  and  maternal  mortality  is  just 
as  much  a  social  problem  as  it  is  a  medical  problem  and  probably  more  of  a  social 
problem  than  it  is  a  medical  problem.  We  are  not  giving  medicines;  we  are  not 
treating  sick  people;  we  do  nothing  of  that  kind.  We  simply  teach  people  how  to 
keep  well  and  readjust  as  far  as  we  are  able  the  bad  effects  of  wrong  environment, 
including  the  big  social  questions  relating  to  their  method  of  living,  overcrowding, 
living  wages,  proper  hygiene,  care  of  the  body,  how  much  fresh  air  and  exercise 
they  need,  how  the  babies  should  be  taken  care  of  and  fed.  Infant  mortality  is 
very  largely  a  social  problem  and  an  economic  problem. 

The  Chairman.  Let  us  assume  that  is  so;  but  when  it  comes  to  the  personnel  of 
the  directing  force  and  oi^erators  of  your  division,  would  it  not  appear  from  your 


22  PUBLIC   PROTECTION    OF   MATERNITY   AND  INFANCY. 

statement  that  the  inspiration  and  direction  comes  from  what  might  be  termed  a 
medical  source? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  How  much  money  do  you  spend  in  your  division? 

Dr.  Baker.  About  1900,000  a  year. 

The  Chairman.  What  percentage  of  that  is  for  overhead  and  how  much  goes  into 
the  field  forpe  work? 

•  Dr.  Baker.  I  should  hesitate  to  say  positively.  I  should  say  possibly  5  per  cent 
was  overhead. 

The  Chairman.  You  would  not  want  to  be  quoted  on  that? 

Dr.  Baker.  I  would  not  want  to  be  quoted  accurately  on  that. 

The  Chairman.  Would  you  be  willing  to  put  that  in  your  testimony? 

Dr.  Baker.  I  will.     I  can  get  it  for  you  very  readily,  but  it  is  approximately  that. 

The  Chairman.  Have  you  studied  the  financial  features  of  this  bill  so  that  you 
would  want  to  testify  as  to  the  question  of  economy  in  operating  under  the  bill  or 
maybe  under  some  other  arrangement? 

Dr.  Baker.  As  I  remember  the  bill,  it  is  approximately  5  per  cent. 

The  Chairman.  I  do  not  mean  that.  I  do  not  want  to  waste  any  time  if  I  can 
help  it.  Have  you  considered  whether  or  not  the  expenses  of  operating  under  this 
bill,  to  obtain  the  results  you  desire  and  that  we  all  desire,  would  be  greater  or  less 
under  the  provisions  of  this  bill  or  under  the  direction,  say,  of  the  Public  Health 
Service? 

Dr.  Baker.  I  can  not  see  there  would  be  any  difference  whatever  in  the  admin- 
istrative costs,  whether  under  the  Public  Health  Service  or  the  Federal  Children's 
Bureau;  but  I  should  assume  the  administrative  costs  under  either  bureau  may 
probably  be  greater  than  the  administrative  cost  in  a  compact  organization  such  as 
we  have  in  New  York  City. 

The  Chairman.  Oh,  yes;  they  are  not  comparable.  But  wouldn't  you  feel  that 
it  is  quite  likely  there  would  be  the  cost  of  setting  up  an  organization  from  the  begin- 
ning to  operate  in  behalf  of  the  Children's  Bureau;  whereas  the  Public  Health  has 
its  own  set-up  all  over  the  country? 

Dr.  Baker.  No,  sir;  I  can  not  see  that  that  would  make  any  difference. 

The  Chairman.  You  think  there  would  be  no  initial  cost  in  establishing  a  new 
department  under  the  Children's  Bureau? 

Dr.  Baker.  I  think  not.  The  provisions  of  the  bill,  as  I  read  them  are  that  the 
States  shall  make  up  a  program  and  submit  it  to  the  Federal  bureau,  and  if  it  is 
approved  by  the  advisory  board  created  in  the  act  the  Federal  Government  there- 
upon appropriates  the  necessary  money,  and  the  work  is  carried  out  entirely  under 
the  State  and  all  administrative  expenses  and  overhead  would  be  borne  by  the 
State. 

The  Chairman.  How  long  havft  you  bad,  in  New  York,  an  accurate  registration  of 
the  births  of  children? 

Dr.  Baker.  For  about  15  years,  I  think,  or  a  little  longer  than  that. 

The  Chairman.  Has  it  been  improving  from  year  to  year? 

Dr.  Baker.  It  was  95  per  cent  perfect  when  it  was  accepted  by  the  Census  Bureau 
and  since  that  time  the  registrar  of  records,  I  believe,  now  claims  it  to  be  98  per  cent 
perfect,  which  would  show  an  improvement;  but  it  is  over  95  per  cent  perfect  in 
any  event. 

The  Chairman.  You  would  feel  perhaps — I  say  perhaps — that  the  improvement  in 
the  death  rate  of  children  might  be  offset  a  little  bit,  might  be  offset  in  some  manner, 
by  the  better  registration  of  births? 

Dr.  Baker.  Not  that  2  or  3  per  cent  would  not  have  made  any  perceivable  effect 
upon  the  death  rate. 

The  Chairman.  About  how  many  children  are  born  now? 

Dr.  Baker.  About  135,000  a  year. 

The  Chairman.  Three  per  cent  of  that  would  make  quite  a  bunch. 

Dr.  Baker.  But  that  would  be  the  births  upon  which  you  computed  your  death 
rate;  it  would  not  be  your  deaths;  so  that  your  computation  per  1,000  would  be 
affected  very  little  indeed  by  that.  Really,  we  have  worked  it  all  out  and  it  makes  a 
difference  of  hardly  a  point  in  the  death  rate  either  way. 

The  Chairman.  What  has  been  the  record  in  New  York  in  respect  to  the  death  of 
children  after  they  are  a  year  or  so  old,  for  the  next  five  years? 

Dr.  Baker.  The  death  rate  of  those  children  since  we  have  been  following  it  in 
the  last  12  years,  the  death  rate  of  the  children  between  1  and  5  and  5  and  10,  has 
been  reduced  a  greater  proportion  than  the  death  rate  under  1.  This  has  followed 
almost  in  order  in  the  group  of  children  who  have  been  growing  Up  gradually  under 
this  care,  thereby  showing  they  have  not  only  kept  alive  the  first  year  but  are  alive 
and  well  at  the  end  of  5  years  and  then  at  the  end  of  10  years. 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCJY.  23 

The  Chaiu.man.  Would  you  welcome  a  transfer  of  your  authority  and  your  duties 
to  the  de])artnient  of  labor  of  New  York  State? 

Dr.  IJakkk.  Would  I? 

The  Chaikman.  Yeft. 

Dr.  Bakkk.  No;  1  am  perfectly  HatiHfied  and  am  getting  on  very  well  whore  I  am. 
I  I^aughter.  | 

The  Chaiu.man.  What  would  be  your  attitude  if  somebody  would  introduce  a  bill 
in  the  New  York  State  Legislature  or  Aasembly  which  would  provide  that  hereafter 
all  boardn  in  New  York  which  had  to  do  with  the  work  you  are  doing  nhould  come 
under  the  direction  oi  the  commiasioner  of  labor  of  the  State  of  New  York;  would  you 
favor  that  or  object  to  it? 

Dr.  Bakkr.  I  would  be  somewhat  in  opposition  to  it.  1  would  feel  if  the  health 
.services  had  l)een  doing  this  work  apparently  well  for  the  last  12  or  15  years,  and 
suddenly  you  introduced  a  bill  to  turn  it  over  to  the  department  of  labor,  I  would 
oppose  it  just  as  much  in  the  Federal  Government  as  in  the  State  government. 

The  Chairman.  Would  you  favor  or  object  to  it  in  New  York  State? 

Dr.  Baker.  As  things  are  now  in  New  York  State,  I  must  qualify  my  answer.  The 
department  of  labor  has  never  done  any  work  of  this  kind;  it  has  never  attempted  to 
do  any  work  of  this  kind.  The  department  of  health  has  done  it  for  12  or  13  years  and 
apparently  with  good  results,  and  of  course,  naturally,  I  would  object  to  turning  it 
over  to  a  department  which  knew  nothing  about  it,  did  not  pretend  to  know  anything 
about  it,  and  had  done  nothing  with  it. 

The  Chairman.  And  for  the  reasons  you  assign? 

Dr.  Baker.  Yes. 

The  Chairman.  Now,  when  you  come  to  the  Federal  situation,  will  you  kindly 
suggest  to  the  committee  what  work  along  infant  care  has  ever  been  done  by  the 
Labor  Department  of  the  Federal  Government. 

Dr.  Baker.  I  tried  a  few  minutes  ago  to  outline  that — the  work  of  the  Federal 
Children's  Bureau.  They  have  published  quite  a  large  number  of  pamphlets — I  am 
quite  sure  Miss  Lathrop  would  be  better  able  to  answer  this  than  I  can,  but  they  have, 
since  they  were  organized  about  eight  years  ago,  done  a  tremendous  amount  of  re- 
search work  in  the  various  cities  and  various  communities  throughout  the  United 
States,  studying  the  causes  of  infant  and  maternal  mortality  and  the  best  means  by 
which  they  could  be  combatted.  They  have  done  a  good  deal  of  work,  also,  in  regard 
to  children  at  work  in  industries,  which  does  not  come  under  this  bill,  and  three  or 
four  years  ago  they  organized  and  carried  out  a  children's  year  in  the  United  States. 
Previous  to  that  children's  year  there  were,  I  believe,  eight  States  that  had  a  bureau 
of  child  hygiene.  As  a  result  of  the  propaganda  and  work  done  during  the  children's 
year,  and  the  enormous  interest  aroused  by  the  Children's  Bureau,  other  States  have 
started  to  organize  bureaus  of  child  hygiene,  so  that  at  the  present  time  there  are  35 
States  of  the  L'nion  that  have  a  child  bureau  of  hygiene,  and  the  number  has  increased 
from  8  to  35  as  a  result  of  the  work  of  the  Children's  Bureau  during  the  children's  year. 

The  Chairman.  That  is  interesting;  but  the  query  was  whether  or  not  the  Labor 
Department  of  the  United  States  Goverament  has  ever  Hndertaken  to  do  any  medical 
Avork  or  anything  approaching  medical  work  in  respect  of  the  causes  of  maternal  and 
infant  deaths,  so  far  as  you  know? 

Dr.  Baker.  I  am  afraid,  Mr.  Chairman,  I  do  not  entirely  comprehend  your  ques- 
tion. They  are  prohibited  by  the  very  nature  of  their  being  and  the  legislation  that 
brought  them  into  being,  from  doing  administrative  work;  they  are  not  allowed  to  do 
administrative  work.  Nor  do  I  assume  that  this  bill  gives  the  Children's  Bureau  the 
authority  to  carry  out  administrative  work  in  the  various  States.  I  would  be  opposed 
to  it  in  such  case. 

The  Chairman.  I  am  presenting  this  thought  by  \drtue  of  the  inspiration  which 
comes  from  your  own  testimony.  You  have  set  up  pretty  conclusively  and  answered 
pretty  accurately  that  your  work,  and  I  think  you  are  doing  a  most  excellent  work, 
is  based  and  carried  on  under  medical  direction,  and  you  do  not  want  the  department 
of  labor  of  New  York  State  to  get  their  hands  on  it,  because  they  have  not  done  those 
things  that  the  medical  department  of  the  State  with  which  you  are  working  have 
done.  Now,  I  ask  you,  in  order  to  bring  the  question  to  this  bill,  whether  or  not  you 
find,  in  the  relations  of  the  Labor  Department  to  the  Federal  Government,  that  they 
have  done  any  more  work  on  maternal  and  infant  deaths  than  the  labor  department 
of  New  York  State. 

Dr.  Baker.  Oh,  emphatically.  I  believe  we  are  confusing  two  different  types  of 
organization.  The  work  of  the  bureau  of  child  hygiene  of  New  York  (.'ity  is  distinctly 
administrative  work.  This  bill  provides  that  the  various  States  carry  out  the  admin- 
istrative programs  we  carry  out  in  New  York  City.  The  Federal  bureau  is  to  act 
wholly  in  an  advisory  capacity  in  regard  to  the  administrative  program  and  pre- 


24  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

sumably  as  to  whether  they  are  keeping  up  that  program.  Now,  if  the  New  York 
State  department  of  labor  has  had  as  good  a  background  as  the  Federal  Department 
of  Labor  in  the  Children's  Bureau,  and  had  done  anything  like  the  work  the  Federal 
Department  of  Labor  has  done  in  fitting  themselves  to  act  in  an  advisory  capacity, 
I  certainly  would  have  no  objection  to  their  advising  me  to  the  fullest  extent  on  the 
administrative  functions. 

The  Chairman.  How  would  you  like  to  have  the  United  States  Goverimient, 
through  Congress,  legislate  in  such  a  way  as  to  put  your  New  York  health  organization, 
with  which  you  are  connected  and  of  which  you  are  the  director,  as  to  its  future  opera- 
tions, under  any  department  of  the  Federal  Government? 

Dr.  Baker.  As  far  as  this  bill  is  concerned,  if  you  mean  putting  it  under  in  that 
sense,  I  should  have  no  feeling  whatever  about  submitting  any  program  we  have  in 
New  York  to  the  Federal  Government  for  approval. 

The  Chairman.  And  you  would  be  willing  to  have  the  Federal  Government  step 
in  and  supersede  the  New  York  State  authorities? 

Dr.  Baker.  No,  sir;  and  I  do  not  think  there  is  anything  whatever  in  this  bill  that 
supersedes  the  authority  of  the  State  by  any  Federal  department;  but,  as  far  as  this 
bill  is  concerned,  any  relation  which  this  bill  provides  will  be  quite  welcome  in 
New  York  City. 

The  Chairman.  As  the  representative  of  the  New  York  City  organization,  you  are 
well  satisfied  with  things  as  they  are  in  the  health  department? 

Dr.  Baker.  Yes,  sir. 

The  Chairman.  You  do  not  want  State  interference,  if  you  can  help  it? 

Dr.  Baker.  I  would  not  mind  if  it  were  helpful;  not  at  all.  I  should  be  glad  to 
get  advice  any  place  I  could. 

The  Chairman.  But  would  you  look  with  favor  upon  the  establishment  or  the 
passage  of  legislation  in  Ne^\  York  State  which  would  take  your  local  department  out 
of  the  hands  of  the  local  board  of  health? 

Dr.  Baker.  That  is  so  intimately  connected  with  all  the  questions  of  city  govern- 
ment, Mr.  Chairman,  I  think  one  can  hardly  answer  it.  I  should  not  want  to  see 
just  the  bureau  of  child  hygiene  placed  under  State  control  and  all  the  rest  left  in 
city  control ;  but  certainly  if  the  whole  of  it  was  placed  in  State  control  I  should  have 
no  objection  whatever  to  the  bureau  of  child  hygiene  going  along  with  it. 

The  Chairman.  But  you  do  feel  that  New  York  City  can  take  care  of  its  own  health 
functions? 

Dr.  Baker.  Yes,  sir;  and  I  look  upon  this  in  the  light  that  the  States  will  be  stim- 
ulated to  take  care  of  th%ir  own,  and  I  think  they  should;  and  certainly  adminis- 
tratively the  bill  provides  they  shall  entirely  take  care  of  their  own. 

The  Chairman.  Do  you  conceive  that  the  proponents  of  this  bill  will  deny  any 
intention  of  them  having  any  administrative  authority  extended  to  it  by  virtue  of 
the  authority  it  might  get  under  this  bill? 

Dr.  Baker.  May  I  say  in  that  connection ■ 

The.  Chairman.  Say  anything  you  want  to,  Doctor;  we  are  here  to  learn. 

Dr.  Baker.  When  this  bill  was  first  introduced  in  Congress  there  was  a  clause  in 
this  bill  wliich  provided  for  the  organization  in  each  State  of  a  separate  committee 
to  work  out  a  program  under  the  general  control  of  the  Federal  Cliildren's  Bureau, 
and  1  appeared  before  the  House  committee  in  opposition  to  the  bill  on  that  ground. 
I  am  absolutely  opposed  to  any  Federal  administrative  functions  in  the  States,  and 
if  tliis  bill  were  to  be  so  amended  as  to  give  administrative  functions  to  a  Federal 
department,  to  come  into  the  States  and  carry  on  the  work,  I  think  I  can  promise 
you  I  will  be  down  here  to  appear  against  it  again. 

The  Chairman.  Now,  I  do  not  want  to  detain  you  too  long;  just  one  more  question. 
Would  you  be  in  favor  of  amending  this  bill  in  such  a  way  as  positively  to  confine 
the  duties  and  authority  of  the  Children's  Bureau  to  the  point  of  being  advisory  to 
the  proper  organizations  in  the  several  States? 

Dr.  Baker.  I  certainly  would,  and  I  look  upon  it  as  being  so  confined  as  it  stands 
at  the  present  time. 

Mr.  Cooper.  Just  one  short  question,  and  I  ask  it  for  the  record :  Do  you  believe  there 
is  anything  in  the  contemplated  legislation  or  the  bill  which  we  are  considering  that 
would  permit  the  Federal  Government  to  take  your  work  over  in  New  York? 

Dr.  Baker,  No,  sir;  not  in  any  way,  or  interfere  in  any  way  with  the  work  we  are 
doing. 

The  Chairman.  A  member  of  the  committee  has  asked  me  to  ask  you  one  further 
question,  although  I  think  you  have  already  answered  it:  Are  you  opposed  to  haviag 
the  Federal  Government,  through  the  Children's  Bureau  as  established  now  by  law, 
take  on  any  absolute  administrative  authority? 


PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY.  25 

Dr.  Baker.  Well,  administrative  authority  may  be  construed  in  various  ways. 
If  you  mean  by  that  any  direct  administrative  authority  in  the  variou.s  States,  or  any 
part  of  the  various  States,  I  am  opposed  to  it;  yes,  sir. 
Mr.  Lea.  Doctor,  in  section  8  of  this  bill  it  provides: 

"That  any  State  desiring  to  avail  itself  of  the  })eneiits  of  this  act  shall,  by  its  agency 
described  in  section  4,  submit  to  the  Children's  Bureau  for  its  approval  detailed  plans 
for  carrying  out  the  provisions  of  this  act.  1  hose  plans  shall  include  the  provisions 
to  be  made  in  the  State  tor  the  administration  of  the  act  the  provision  of  instruction  in 
the  hygiene  of  maternity  and  infancy  through  public-health  nurses,  consultation 
centers,  and  other  suitable  methods." 

Now,  would  you  legard  that  provision  as  in  any  way  contrary  to  what  you  have 
Btated? 
Dr.  Baker.  No.  sir. 

Mr.  Lea.  That  would  give  the  national  organization  the  right  to  determine  the 
policy  of  the  administration  of  the  law,  would  't  not? 

Dr.  Baker.  I  look  upon  the  bill  as  it  stands  now,  as  giving  the  Children's  Bureau 
simply  the  authority  to  pass  upon  the  programs  submitted  by  the  States.  The  Child- 
ren's Bureau,  by  virtue  of  its  knowledge  with  reference  to  these  questions  could 
standardize  programs  or  make  suggestions  for  the  various  States  which  would  probably 
be  much  better,  in  many  cases,  than  the  methods  which  the  States  could  work  out 
for  themselves. 

I  am  absolutely  opposed  to  any  administrative  functions  by  the  Federal  Govern- 
ment in  the  States.  But  I  can  not  assume  that  the  Government  could  give  out  money 
for  a  program  without  considering  the  program  determined  upon. 

Mr.  Lea.  The  State  would  have  to  subordinate  its  plans  to  this  bureau? 
Dr.  Baker.  To  get  the  money  it  would,  but  there  is  nothing  compulsory  about  it. 
Mr.  Lea.  It  could  refuse  to  accept  the  benefits  of  this  act? 
Dr.  Baker.  Absolutely. 

Mr.  Cooper.  Mr.  Lea,  may  I  say  that  under  the  Good  Roads  Association  law,  we 
require  the  State  to  meet  certain  conditions? 
Mr.  Lea.  Yes;  this  is  the  same  plan. 

Dr.  Baker.  I  should  think  it  would  be  dangerous  to  give  money  from  the  Treasury 
of  the  Federal  Government  without  some  approval  being  given  to  the  project  for 
which  it  is  to  be  spent. 

Mr.  Lea.  That  is  what  I  thought.     Do  you  consider  that  objectionable? 
Dr.  Baker.  No,  sir. 

Mr.  Merritt.  Doctor,  I  wanted  to  ask  whether  under  the  New  York  law  there  is  any 
provision  for  maternity  benefits;  do  the  mothers  get  any  bonus  or  bounty  as  mothers? 
Dr.  Baker.  No,  sir. 

Mr.  Merritt.  Is  free  milk  furnished  to  the  babies? 

Dr.  Baker.  No,  sir;  they  pay  for  the  milk.     When  we  find  cases  where  they  are 
unable  to  pay  for  the  milk,  by  cooperation  with  relief  and  welfare  agencies,  we  get  the 
money  and  pay  for  the  milk,  and  in  that  way  give  it  to  them  free.     But  in  the  greatest 
proportion  of  these  cases  the  mothers  pay  for  the  milk. 
Mr.  Burroughs.  Just  one  question,  Doctor.     I  hope  we  do  not  tire  you. 
Dr.  Baker.  I  am  very  glad  to  answer. 

Mr.  Burroughs.  I  wondered  if  you  understood  that  the  conditions  were  laid  down 
in  this  bill  with  sufficient  definiteness,  upon  compliance  with  which  the  States  would 
be  entitled  to  participate  in  this  fund,  and  so  that  in  case  they  were  refused,  unjustly, 
bj'  the  Federal  officials,  a  mandamus  would  lie,  or  they  would  be  compelled  by  the 
Federal  courts  or  any  courts  to  pay  over  the  money;  I  mean,  in  case  the  conditions  had 
been  absolutely  met? 

Dr.  Baker.  I  do  not  see  how  a  mandamus  would  lie,  because  I  can  not  understand 
how,  according  to  the  provisions  of  the  bill,  there  is  any  higher  authority  than  this 
advisory  board. 
Mr.  Burroughs.  In  other  words,  it  is  left  to  their  discretion? 
Dr.  Baker.  It  is  left  to  their  discretion,  and  the  bill  seems  to  me  to  end  there.     I 
assume  there  might  be  a  legal  procedure  which  might  get  out  through  another  group; 
but  there  is  no  appeal,  apparently,  from  this  advisory  board. 
Mr.  Burroughs.  I  wondered  if  you  understood  that. 
Dr.  Baker.  That  is  my  interpretation  of  it. 

Mr.  Towner.  For  the  record,  and  also  for  the  information  of  the  committee,  I  want 
to  read  the  act  creating  the  Children's  Bureau  [reading]:  "The  said  bureau  shall 
investigate  and  report  to  said  department " — that  is,  the  Department  of  Labor — ''upon 
all  matters  pertaining  to  the  welfare  of  children  and  child  life  among  all  classes  of  our 
people,  and  shall  especially  investigate  the  questions  of  infant  mortality,  the  birth 
rate,  orphanage,  juvenile  courts,  desertion,  dangerous  occupationd,  accidents  and 


26  PUBLIC   PKOTECTIOjST    of    maternity   and  IlSTFAlSrCY. 

diseases  of  children,  employment  legislation  affecting  children  in  the  several  States 
and  Territories." 

Mr.  Graham.  May  I  ask  Jndge  Towner  a  question? 

The  Chairman.*  Certainly. 

Mr.  Graham.  When  was  this  Children's  Bureau  organized? 

Mr.  Towner.  The  act  was  passed  in  April,  1912. 

Mr.  Graham.  Do  you  know  how  much  of  an  appropriation  it  carried  in  the  current 
appropriation  bill  for  the  next  period  for  that  bureau? 

Mr.  Towner.  No:  but  Miss  Lathrop  can  tell  you. 

Miss  Lathrop.  Just  what  it  had  for  the  past  year,  I  think,  |270,000. 

Mr.  Graham.  Do  you  know  how  much  it  was  for  the  first  year? 

Mr.  Towner.  $25,000. 

Mr.  Graham,  judge  Towner,  how  large  a  personnel  has  the  Children's  Bureau  at 
this  time,  do  you  know? 

Mr.  Towner.  No;  I  could  not  tell  you.  I  will  say,  Mr.  Graham,  all  those  figures 
Miss  Lathrop  can  give  you.  I  have  not  looked  the  matter  up  lately.  The  increase 
that  would  be  possible  in  appropriations  under  the  terms  of  the  bill  and  the  amend- 
ment adopted  by  the  Senate  would  limit  the  administrative  features  and  limit  the 
expenditures,  in  so  far  as  this  bureau  are  concerned,  to  $30,000. 

Mr.  Graham.  Would  that  include  the  additional  expenses  provided  in  this  act 
wherein  it  is  stated  that  they  may  employ  such  additional  help  as  they  require,  for 
instance,  under  section  6? 

Mr.  Towner.  That  is  exactly  it.  All  of  their  expenditures  are  limited  to  5  per 
cent  in  the  original  bill,  and  to  3  per  cent  as  amended  by  the  Senate  committee. 

The  Chairman.  Will  Dr.  Baker  resume  just  a  moment  for  the  benefit  of  the  com- 
mittee? 

Dr.  Baker.  I  will  be  glad  to. 

The  Chairman.  Mr.  Denison  wants  to  ask  you  some  questions. 

Mr.  Denison.  There  is  one  point  I  want  to  get  some  information  about,  and  that 
is  the  question  pertaining  to  the  administration  of  the  work  in  New  York.  Do  I 
understand  that  tie  service  of  which  you  are  the  head  has  several  centers  or  offices? 

Dr.  Baker.  Yes,  sir. 

Mr.  Denison.  You  have  these  centers  or  offir-ea,  do  you? 

Dr.  Baker.  Yes;  we  have  an  administiative  office  in  each  of  our  five  boroughs. 
And  then  we  have  68  housing  babies'  and  children's  health  centers. 

Mr.  Denison.  Children's  health  centers? 

Dr.  Baker.  Yes,  sir. 

Mr.  Denison.  What  does  that  consist  of  ? 

Dr.  Baker.  Of  a  store,  and  rooms.  Physically  speaking,  it  is  two  or  three  rooms 
equipped  with  scales,  and  utensils,  to  show  the  mothers  how  to  modify  milk,  and 
there  is  a  doctor's  table  and  desk,  and  so  on.  These  are  consultation  centers,  aleo, 
where  the  mdthers  bring  their  babies,  quite  voluntarily,  and  have  them  examined, 
and  the  younger  children  also  come  there. 

Mr.  Denison.  What  I  called  you  back  to  ask  you  particularly  was  this:  Does 
your  department,  or  any  of  those  connected  with  it,  ever  under  any  circumstances 
take  the  initiative  in  the  administration  of  the  benefits'  you  administer? 

Dr.  Baker.  No,  sir. 

Mr.  Denison.  In  other  words,  do  you  go  out,  or  do  your  representatives  go  out  and 
seek  cases,  or  do  you  depend  upon  them  to  come  to  you? 

Dr.  Baker.  When  we  first  began  we  used  to  take  copies  of  the  birth  certificates  as 
they  came  in,  and  the  nurses  used  to  visit  the  mothers  and  explain  to  the  mothers  the 
workings  of  our  service.  They  asked  them  whether  they  had  their  own  physicians, 
and  explained  to  them  that  if  they  did  not,  that  they  could  go  to  these  places  for 
assistance  and  advice.  After  that,  such  suggestions  as  we  made  we  found  they 
would  gladly  follow.  They  came  in  such  numbers  that  inside  of  a  year  we  had  to 
give  up  any  method  of  canvassing,  and  since  that  time  we  have  hardly  been  able  to 
take  care  of  the  cases  that  come  to  us,  or  to  keep  up  with  the  demands  on  us.  We 
do  have  our  nurses  go  to  the  homes  and  teach  the  mothers  and  the  family  vital  things 
about  the  baby's  care. 

Mr.  Denison.  Do  they  go  voluntarily,  or  only  when  they  are  called  for? 

Dr.  Baker.  They  go  voluntarily.  But  there  is  nothing,  so  far  as  we  have  been  able 
to  observe,  to  lead  anyone  to  suppose  that  this  work  is  not  more  than  welcomed.  In 
fact,  the  people  are  very  anxious  for  it. 

Mr.  Denison.  I  was  wondering  whether  or  not,  in  the  administration  of  the  work, 
you  sought  out  the  homes  or  the  mothers  themselves,  or  whether  you  waited  and  let 
them  seek  you  out? 


PUBLIC   PllOTJiCTIOlSr   OF    MATERNITY  AND   INFANCY.  2? 

Dr.  Bakeh.  We  do  the  latter  entirely  now,  but  in  the  beKinninf;  we  did  go  around 
and  visit  them,  because  it  was  a  new  work  and  we  wanted  to  let  them  know  about  it. 
And  they  came  to  us  in  great  numbers.  They  were  very  glad  to  know  about  our  work. 
At  the  present  time  we  send  f)ut  a  copy  of  the  birth  certificate  to  every  mother,  and 
send  a  note  along  ^vith  it  asking  her  to  keej)  it  as  an  evidence  of  the  legal  age  of  the 
child.  And  we  call  attention  to  the  need  of  pn^per  care  for  the  baby,  and  tell  her 
that  if  she  does  not  have  a  physician  of  her  own,  or  does  not  care  to  go  anywhere  else, 
the  city  is  prepared  to  give  her  instruction  for  the  care  of  her  baby,  if  she  chooses  to 
have  it. 

Mr.  Dknison.  And  if  she  does  choose  to  have  it,  and  comes  to  vou,  this  service  is 
all  free? 

Dr.  Bakeh.  Absolutely. 

Mr.  Denison.  How  far  does  that  free  service  go? 

Dr.  Baker.  All  of  our  service  is  free. 

Mr.  Denison.  Does  the  city  furnish  the  nurses  and  the  physician? 

Dr.  Bakek.  Our  service  is  not  for  the  care  of  sick  people ;  it  is  purely  educational 
work,  and  teaching  the  people  how  to  keep  well;  it  is  not  the  nursing  of  sick  people 
at  all. 

Mr.  Denison.  I  assume  that  when  the  mother  has  given  birth  to  a  child  there  is 
more  or  less  sickness. 

Dr.  Bakek.  No;  we  do  not  give  attention  to  the  mother  at  that  time.  In  New 
York,  in  Manhattan  there  is  an  association  known  as  the  Henry  Street  Nurses'  Asso- 
ciation; and  in  Brooklyn  there  is  the  Visiting  Nurse  Association,  both  of  which  asso- 
ciations are  maintained  by  donations  of  one  sort  and  another,  and  those  associations 
are  prepared  to  furnish  nurses  for  such  service  at  cost  price,  and  they  are  maintained 
for  the  actual  care  of  persons  who  are  sick,  and  they  will  go  to  attend  sick  cases  on  call. 
And  when  we  had  cases  where  the  mother  is  sick  or  the  baby  is  sick,  we  send  for  one 
of  those  nurses. 

Mr.  Denison.  Your  department  does  not  handle  those  cases  at  all? 

Dr.  Baker.  No,  sir;  our  work  is  purely  preventive  work. 

Mr.  Denison.  I  did  not  get  that  in  the  first  place. 

Dr.  Baker.  That  is  what  I  understand  is  the  purpose  of  this  bill. 

Mr.  Mapes.  I  want  to  ask  you  a  question  or  two,  Dr.  Baker.  Your  testimony  has 
been  so  interesting  that  I  hope  you  will  consider  it  a  compliment  rather  than  otherwise 
that  the  members  of  the  committee  desire  to  ask  you  so  many  questions. 

Dr.  Baker.  I  am  very  glad,  indeed,  to  answer. 

Mr.  M^lPes.  I  want  to  ask  you  a  question  along  the  line  of  Mr.  Denison's  question. 
I  have  forgotten  how  many  cases  in  New  York  City  you  said  were  given  personal 
attention. 

Dr.  Baker.  About  60,000  babies  a  year. 

Mr.  Mapes.  Sixty  thousand  babies  a  year? 

-Dr.  Baker.  Yes;  that  is  babies.  When  it  comes  to  school  children  we  reach  about 
a  million  school  children.     We  have  a  doctor  and  a  nurse  in  school  every  day. 

Mr.  Mapes.  Can  you  tell  us  in  just  a  word  what  that  personal  attention  consists  of? 

Dr.  Baker.  Yes.  The  mother  comes  to  the  station,  usually  with  her  baby.  She 
comes  there  either  because  she  is  pregnant  or  she  comes  with  her  baby.  The  baby 
is  undressed,  and  it  is  given  a  thorough  examination;  inquiry  is  made  as  to  how  it  is 
fed^ — and  I  may  say  that  we  have  made  great  progress  in  the  matter  of  feeding  of 
children.  A  gi-eat  deal  of  the  infant  mortality  comes  because  of  the  lack  of  proper 
feeding,  and  we  have  induced  most  of  the  mothers  who  come  to  visit  us  to  nurse  their 
children .  That  is  educational  work  and  has  been  of  great  importance  in  the  reduction 
of  infant  mortality  rate. 

Mr.  Mapes.  I  understood  you  to  say  in  answer  to  Mr.  Denison  that  the  personal 
attention  that  you  give  is  all  given  at  the  centers? 

Dr.  Baker.  That  is  given  at  the  centers.  But  if  the  mother  needs  some  instruction 
in  the  home,  and  we  have  reason  to  believe  the  home  surroundings  are  bad,  or  that 
the  mother  should  be  taught  how  to  modify  the  milk,  the  nurse  goes  to  the  home  in 
the  afternoon  and  the  mother  is  given  instruction  as  to  the  care  of  the  baby,  as  to 
food,  and  how  to  modify  the  milk,  and  general  care  of  the  baby  and  baby  hygiene. 
The  babies  are  kept  under  observation  through  the  second  year,  and  then,  if  possible, 
followed  up  until  school  age,  or  at  least  up  to  five  years. 

The  Chairman.  If  that  is  all  the  questions,  we  are  very  much  obliged  to  you; 
Dr.  Baker. 

Mr.  Towner.  Mr.  Chairman,  I  will  ask  the  committee  to  hear  Dr.  Philip  Van 
Ingen,  clinical  professor  of  diseases  of  children,  college  of  physicians  and  surgeons, 
Columbia  University,  New  York,  and  attending  physician,  children's  department, 
Belle vue  Hospital,  New  York. 

The  Chairman.  We  will  hear  Dr.  Van  Ingen. 


28 


PUBLIC   PEOTECTIOI^   OF   MATEEIsTITY   ANT)   IlSTFAlSrCY. 


STATEMENT  OF  DR.  PHILIP  VAN  INGEN,  CLINICAL  PROFESSOR  OF 
DISEASES  OF  CHILDREN,  COLLEGE  OF  PHYSICIANS  AND  SUR- 
GEONS, COLUMBIA  UNIVERSITY,  NEW  YORK;  AND  ATTENDING 
PHYSICIAN,  CHILDREN'S  DEPARTMENT,  BBLLEVUE  HOSPITAL, 
NEW  YORK. 

Dr.  Van  Ikgbn.  Mr.  Chairman  and  gentlemen  of  the  committee,  you  have  heard 
80  much  from  the  statistics  given  by  Dr.  Baker  as  to  the  needs  of  this  work  that  I  will 
not  take  up  much  of  your  time  on  statistics,  except  to  emphasize  some  of  them,  in  the 
hope  that  they  will  make  still  more  impression.  For  that  purpose  I  shall  only  empha- 
size a  few  of  the  high  points. 

Please  remember  that  last  year,  according  to  the  mortality  statistics  of  the  Depart- 
ment of  Commerce,  Bureau  of  the  Census,  within  the  birth  registration  area,  14,488 
women  died  from  causes  due  to  childbirth.  Also  please  remember  that  among  women 
of  childbearing  age,  which  is  usually  called  from  15  to  45,  for  statistical  purposes,  more 
women  die  from  causes  connected  with  childbirth  than  any  other  cause,  with  the  excep- 
tion of  tuberculosis  and  influenza.  Ten  and  two-tenths  per  cent  of  all  the  women  from 
15  to  45  who  died  during  the  year  1919  died  from  causes  connected  with  childbirth. 

The  Chairman.  What  year? 

Dr.  Van  Ingen.  1919. 

The  Chairman.  And  that  year  only? 

Dr.  Van  Ingen.  I  have  the  figures  here  for  that  year  only,  but  you  will  find  that 
the  figures  apply  to  practically  every  year. 

Mr.  Sanders.  You  say,  except  in  tuberculosis  and  influenza? 

Dr.  Van  Ingen.  Yes;  unless  I  am  mistaken,  1918  and  1919  were  the  only  two  years 
that  the  deaths  connected  with  childbirth  have  not  stood  second  on  the  list  of  the 
causes  of  death  instead  of  third.  There  has  been  a  slow  but  steady  increase  in  the 
number  of  those  deaths  and  the  proportion  of  these  deaths  throughout  the  country. 

As  good  an  authority  as  J.  Whitridge  Williams,  professor  of  obstetrics,  Johns  Hopkins 
University,  announced  before  the  committee  on  Public  Health  and  National  Quaran- 
tine of  the  Senate,  "When  we  come  to  study  the  death  rate  from  childbirth  we  find 
that  the  results  in  the  United  States  are  appalling  and  that  there  has  been  compara- 
tively little  improvement  during  the  last  50  or  75  years.  " 

Dr.  Louis  I.  Dublin,  statistician  of  the  Metropolitan  Life  Insurance  Co.,  informed 
me  just  before  I  came  down  here  that  there  is  a  distinct  though  very  slight  tendency 
to  increase  in  the  mortality  from  puerperal  causes,  and  unless  some  powerful  influence 
is  put  to  work  this  will  go  on. 

I  have  taken  from  the  Mortality  Statistics  of  the  Bureau  of  the  Census  the  mortality 
rates  from  causes  connected  with  childbirth  per  1,000  living  births  in  the  various  States 
in  the  birth  registration  area,  which  I  will  be  glad  to  leave  for  insertion  in  the  record. 

The  Chairman.  Without  objection  the  table  may  be  inserted  in  the  record. 

(The  tables  referred  to  are  here  printed  in  full,  as  follows:) 

Death  rates  from  causes  connected  with  childbirth  per  1,000  living  births  in  birth  registra- 
tion area. 


1915 

1916 

1917 

1918 

1919 

California 

8.0 

Connecticut 

5.6 

4.9 

5.1 
7.2 
7.6 
6.0 
6.7 
6.8 
6.5 
7.4 
5.6 
7.0 
5.7 
8.2 
7.1 

7.5 
10.4 
11.4 
8.0 
8.6 
9.5 
9.2 
8.6 
7.8 
7.8 
8.0 
10.8 
9.7 

6.2 

Indiana 

-    8.4 

Kansas 

8.2 

Kentucky 

6.3 

Maine 

6.8 

7.8 
6.4 
6.0 
6.8 
5.5 
7.2 
5.4 

8.6 

Maryland 

8.4 

Massachusetts , .-.  ... 

5.7 
6.7 
5.2 
6.1 
5.9 

7.1 

Michigan 

7.7 

Minnesota 

6.7 

New  Hampshire 

9.0 

New  York 

6.2 

North  Carolina 

9.3 

Ohio 

7.4 

Oregon 

10.1 

6.4 
6.6 

7.0 

5.8 

6.5 
6.3 

10.5 
9.8 

6.8 

Rhode  Island  . 

11.2 

Utah 

5.9 
6.3 

8.2 
7.4 
5.7 

8.6 
8.0 
10.7 
9.9 
6.0 

8.4 

Vermont 

6.1 

7.8 

8.0 

Virginia 

8.2 

Washington...                  .             .... 

8.6 

Wisconsin ". 

4.8- 

Rate,  all  States 

6.1 

6.2 

6.6 

9.2 

7.4 

In  no  State  is  there  a  downward  trend  except  in  Wisconsin.    Rates  for  1918  must  be  disregarded,  as  the: 
influenza  epidemic  had  a  very  marked  influence,  influenza  being  particularly  fatal  in  pregnant  women. 


PUBLIC    PIJOTKC'TION    OF    MATERNITY   AND   INFANCY. 


29 


Death  rates  from  causes  connected  with  childbirth  per  1,000  living  births  in  cities  of  over 
100,000  population  in  birth  registration  area. 


Bridgeport,  Conn 

New  Haven,  Conn... 
Washington,  D.  C . . . 

Baltimore,  Md 

Boston,  Mass 

Cambridge,  Mass. . . . 

Fall  River,  Mass 

Lowell,  Mass 

Worcester,  Mass 

Detroit,  Mich 

Grand  Rai)ids,  Mich. 
Minneapolis,  Minn... 

St.  Panl,  Minn 

Albany,  N.Y 

Buffalo,  N.Y 

Nevi'  York,  N.  Y 

Rochester,  N.  Y 

Syracuse,  N.  Y 

Pmladelphia,  Pa 

Pittsburgh.  Pa 

Seranton,  Pa 


Rate,  all  cities . 


1915 

1916 

1917 

1918 

6.4 

5.4 

6.1 

8.3 

0.5 

5.9 

4.5 

6.0 

7.0 

10.1 

8.5 

9.1 

7.6 
7.1 

6.9 
9.1 

8.9 
11.6 

8.3 

5.0 

5.2 

6.5 

11.6 

3.6 

6.2 

6.0 

5.5 

6.8 

3.9 

7.0 

7.6 

6.7 

7.7 

9.1 

9.0 

7.1 

7.0 

6.5 

8.4 

6.7 

5.7 

7.2 

11.6 

5.6 

5.7 

5.2 

6.9 

4.7 

7.6 

5.0 

9.5 

S.5 

7.0 

9.3 

10.7 

6.0 

5.4 

4.9 

7.6 

5.6 

5.3 

5.1 

7.3 

6.5 

4.1 

5.5 

6.1 

5.1 

5.7 

6.9 

8.0 

6.8 

7.5 

6.4 

9.7 

7.9 

9.2 

10.0 

10.1 

8.3 

8.8 

8.2 

12.1 

6.4 

6.5 

7.0 

9.6 

1919 


5.5 
4.1 
8.5 
8.9 
9.1 
6.5 
4.1 
7.2 
8.0 
7.6 
8.5 
7.3 
4.7 
6.6 
7.8 
5.7 
9.3 
8.5 
7.3 
8.4 
11.8 


7.9 


Only  cities  which  have  been  in  the  birth  registration  area  4  years  or  over  are  included.  Of  these  21  cities, 
only  6  show  a  downward  tendency.    Figures  for  1918  must  be  disregarded.    (See  State  figures.) 

Dr.  Van  Ingen.  When  we  come  to  the  second  purpose  for  which  this  bill  is  proposed, 
namely,  the  protection  of  infancy  and  promotion  of  infant  hygiene,  we  must  divide 
up  the  subject  of  infant  mortality  somewhat.  Infant  mortality  is  the  number  of 
<leaths  under  1  year  per  thousand  births  during  that  year.  When  we  study  the  causes 
of  these  deaths  from  the  statistics  available,  we  find  a  very  encouraging  decrease  in 
the  general  infant  mortality  rate  throughout  the  country.  But  when  we  come  to  look 
further  we  find  this  improvement  is  entirely  in  the  mortality  among  babies  who  have 
passed  through  the  first  month  of  life.  It  is  a  startling  fact  that  in  the  year  1919,  of 
all  the  babies  under  1  year  of  age  who  died,  47.4  per  cent  were  under  one  month  of 
age,  and  33J  per  cent  were  under  one  week  of  age.  The  statement  of  a  French  scientist' 
some  years  ago  that  a  baby  that  is  born  into  this  world  has  less  chance  to  live  a  week 
than  a  man  of  90  is  almost  true  to-day.  1  have  not  got  the  life  tables  here,  and  I  am 
not  enough  of  a  statistician  to  thoroughly  understand  the  life  tables,  I  am  sorry  to  say. 
Eut  the  fact  is  that  that  very  nearly  holds  true  to-day,  that  a  baby  that  is  born  into  the 
world  has  less  chance  to  live  a  week  than  a  man  of  90  years  of  age. 

Not  only  has  the  death  rate  under  1  month  not  improved,  but  the  proportion  of 
deaths  under  1  month  has  steadily  increased  throughout  this  country.  W^e  find  there 
is  a  slow  but  steady  increase  in  the  proportion  of  infant  deaths  which  occur  during  the 
first  month  of  life.  It  has  been  proven  by  medical  men  that  those  deaths  among 
children  under  1  month  of  age,  the  majority  of  them  at  any  rate,  are  due  to  causes 
acting  through  the  mother  on  the  child  before  it  is  born.  That  is  the  reason  for  advo- 
cating prenatal  care.  To  repeat,  it  has  been  shown  without  doubt,  that  the  deaths  of 
babies  under  1  month  of  age,  are  almost  entirely  due  to  causes  acting  on  the  mother 
before  the  baby  is  born. 

Mr.  HocH.  How  do  you  account  for  that  decrease  where  deaths  occurred  after  1 
month  of  age,  and  an  increase  in  the  death  rate  where  death  occurred  before  the  child 
Avas  1  month  of  age? 

Dr.  Van  Ingen.  I  did  not  mean  to  say  there  was  an  increase  in  this  rate.  I  said 
it  was  practically  stationary,  and  that  the  proportion  of  deaths  that  occur  during  the 
first  month  has  been  increasing.  The  reason  for  improvement  in  the  death  rate  after 
1  month  is  that  the  deaths  after  1  month  of  age  are  largely  due  to  causes  which  may 
be  preventable  in  another  way;  bad  feeding,  lack  of  maternal  nursing,  housing  con- 
ditions, and  bad  conditions  of  living.  In  other  words,  they  are  conditions  which  can 
be  tackled  by  teaching  the  mothers  common-sense  principles  of  how  to  take  care  of 
her  children,  which  the  animal  is  born  with. 

Mr.  HocH.  I  unders'ood  that  reason  very  well,  but  I  was  wondering  why  the  same 
agencies  that  have  been  operating  to  improve  the  death  rate  above  1  month  have  not 
also  been  operating  to  improve  the  rate  below  1  month.  I  understood  you  to  say 
there  was  some  improvement  where  death  occun-ed  after  1  month.  I  understand  that 
is  the  purport  of  your  statement. 


39  PUBLIC   PROTECTION   OF    MATER^-ITY   AND  INFANCY. 

Dr.  Van  Ingbn.  It  is  perfectly  possible  to  lower  the  infant  mortality  rate  among- 
infants  under  one  month  of  age.  Very  little  has  been  done  along  that  line,  except  in 
a  small  way  in  a  number  of  cities,  and  in  some  of  the  cities  in  a  large  way,  as  Dr.  Baker 
has  told  you.  I  can  give  you  some  figures  in  a  minute  which  I  think  will  answer 
your  question,  sir. 

Mr.  HocH.  Do  you  think  the  improvement  in  the  death  rate  where  death  occurred 
after  one  month  of  age  has  been  due  to  agencies  which  operate  throughout  the  country? 

Dr.  Van  Ingen.  I  do  not  think  there  is  anv  question  about  it.  I  think  if  you  study 
the  situation  throughout  the  country,  you  will  come  to  the  conclusion  that  the  funda- 
mentals of  taking  care  of  children  have  been  taught  by  these  agencies  throughout  the 
country,  and  that  it  is  in  a  large  measure  the  cause  of  the  improvement.  If  you 
watch  the  infant  mortality  rates  throughout  the  country  and  notice  the  activity  of 
the  agencies  referred  to,  you  will  see  that  they  go  hand  in  hand. 

New  York  established  its  first  bureau  of  hygiene  in  1908.  The  next  year  was  the 
first  year  in  which  there  was  a  marked  drop  in  infant  mortality.  That  year  they  got 
to  work,  but  it  was  not  very  good  work,  because  we  did  not  know  any  better.  We 
were  not  then  emphasizing  the.  educational  side  of  it.  The  educational  side  began 
to  be  emphasized  in  1911,  and  it  was  after  1911  that  the  drop  in  the  infant  mortality 
began  to  be  very  apparent,  and  it  has  been  going  down  ever  since. 

Mr.  HocH.  Are  there  any  agencies  now  operating  that  are,  as  a  matter  of  fact,  devot- 
ing themselves  to  instruction  that  would  lead  to  a  reduction  of  the  death  rate  of  chil- 
dren after  one  month  of  age,  that  are  not  also  operating  to  disseminate  instruction 
which  would  tend  to  lower  the  death  rate  below  one  month  of  age? 

Dr.  Van  Ingen.  Yes,  sir;  a  great  many  of  them,  because  it  is  an  utterly  different 
proposition.  As  I  said,  the  greatest  influences  on  infant  mortality  in  children  below 
one  month  of  age  are  causes  acting  on  the  mother  before  the  child  is  born,  and,  there- 
fore, the  instruction  has  to  be  done  before  the  baby  is  born.  The  instruction  for 
reducing  the  mortality  in  children  after  one  month  of  age  is  a  different  proposition, 
and  that  is  usually  done  at  the  centers  where  the  babies  are  taken. 

Mr.  Graham.  Before  you  proceed.  Doctor,  I  would  like  to  ask  you  a  question: 
I  have  been  looking  at  this  table  which  you  have  presented  here,  and  there  are  some 
very  interesting  figures  here.  But  I  observe  that  there  is  a  note  on  the  second  table 
that  the  figures  for  the  year  1918  must  be  disregarded.  What  is  the  matter  with  those 
figures? 

Dr.  Van  Ingen.  I  said  that  those  should  be  disregarded  because  they  appear  to 
prove  my  point  too  well  for  one  thing.  And  the  second  thing  is  that  that  was  the 
influenza  year.  There  were  more  maternal  deaths  that  year  than  any  other  year. 
Influenza  had  a  very  fatal  effect  on  pregnant  women.  The  mortality  rate  was  higher 
among  pregnant  women  in  the  year  1918  than  any  other  year,  and  it  was  caused  by 
influenza,  and  that  is  the  reason  that  that  year  should  be  disregarded. 

Mr.  Graham.  They  are  correct  figures,  however? 

Dr.  Van  Ingen.  Yes;  but  they  are  abnormal  on  account  of  the  influenza;  and  the 
peculiarly  fatal  effect  of  influenza  on  pregnant  women  they  should  be  disregarded,  I 
think. 

Mr.  Graham  asked  a  question  a  few  minutes  ago  of  Dr.  Baker  in  regard  to  the  maternal 
mortality  rate  among  the  foreign-born  population.  I  think  it  was  Mr.  Graham  that 
asked  the  question.  In  the  birth  registration  area,  the  number  of  deaths  from  causes 
due  to  childbirth,  among  the  native  population  was  7.4  per  1,000  births;  among  the 
foreign-born  population  it  was  5.6,  which  shows  that  it  is  higher  among  the  American 
women. 

The  Chairman.  Will  you  pardon  me,  but  the  table  which  has  been  presented  here 
by  Dr.  Baker  for  the  record  shows  that  the  whol-';  average  wa?  7.4. 

Dr.  Van  Ingen.  Yes,  sir. 

The  Chairman.  If  it  was  7.4  for  the  worst,  and  5.6  for  the  best,  how  do  you  get  that 
result? 

Dr.  Van  Ingen.  I  did  not  include  the  worst;  the  worst  is  among  the  Negro  popula- 
tion. 

The  Chairman.  Do  you  include  Rhode  Island? 

Dr.  Van  Ingen.  No,  sir.  The  birth  registration  area  includes  North  Carolina,  South 
Carolina,  and  Virginia,  which  liave  a  large  Negro  population,  and  the  maternity  mor- 
tality rate  is  12  and  over. 

The  Chairman.  You  have  excluded  that? 

Dr.  Van  Ingen.  No,  sir. 

The  Chairman.  Will  you  kindly  repeat  just  what  you  did  mean? 

Dr.  Van  Ingen.  I  said  the  mortality  among  mothers,  native  born  white,  was  7.4, 
in  the  birth  registration  area. 

The  Chairman.  In  a  limited  area? 


PUBLIC  PROTECTION    OF    MATERNITY   AND   INFANCY.  81 

Dr.  Van  Ingkn.  Yea;  the  birth  registration  States,  which  were  22  in  number,  and 
the  District  of  CoUinibia.  The  reason  why  the  rate  is  not  lower  for  the  whole  area,  but 
is  the  same  as  that  for  the  native  born  white  women,  7.4,  is  befause  the  death  rate 
among  the  mothers  of  the  Negro  race  is  over  12,  as  you  will  iind  from  the  table  in  these 
"Mortality  statistics,  1919." 

Mr.  Cooper.  Doctor,  may  I  ask  you  a  question  there? 

Dr.  Van  Inoen.  Certainly. 

Mr.  Cooper.  What  did  you  say  the  death  rate  was  among  tlie  white  foreign  born 
mothers? 

Dr.  Van  In(!EN.   Five  and  six -tenths  per  1,000  live  births. 

Mr.  Cooper.  And  is  this  true  that  these  white  foreign-born  mothers  accept  this  help, 
such  as  Dr.  Baker  is  doing  with  her  force,  more  readily  than  the  native-born  white 
mothers? 

Dr.  Van  Ingen.  All  I  can  say  is,  my  personal  opinion  is  they  do.  I  have  never 
made  a  study,  and  do  not  know  whether  Dr.  Baker  will  indorse  what  I  say  or  not,  but 
in  the  cities  I  think  we  have  an  easier  time  with  the  foreign-born  non-English- 
speaking  people. 

Mr.  Cooper.  If  that  is  true,  it  speaks  very  well  for  this  organization,  does  it  not? 

Dr.  Van  Ingen.  It  speaks  well  for  it,  because  there  so  many  of  the  native  whites 
are  in  the  more  rural  States;  our  foreign-bom  population  is  so  largely  centered  in  the 
city,  as  against  the  country. 

The  Ch.\irman.  Do  you  subscribe  to  the  statement  that  the  United  States  stands 
seventeenth  in  the  matter  of  infant  mortality? 

Dr.  Van  Ingen.  I  accept  it.  I  have  never  worked  out  the  accuracy  of  the  figures 
myself. 

The  Chairman.  And  if  there  are  such  a  large  number  of  deaths,  and  the  mortality  is 
so  great  among  the  colored  mothers,  the  large  number  of  deaths  among  them  may  be 
accountable  for  swelling  to  a  considerable  degree  the  number  of  deaths  in  the  United 
States.     Have  you  any  views  on  that  subject? 

Dr.  Van  Ingen.  I  tliink  I  do  not  quite  understand  you,  Mr.  Chairman. 

The  Chairman.  Do  you  think  our  position  of  being  seventeenth  in  the  matter  of 
mortality  among  mothers  due  to  causes  connected  with  cliildbirth  is  due  to  the  fact  that 
there  are  so  many  misfortunes  coming  to  the  colored  mothers  which  have  not  been 
taken  into  account  in  this  table?  For  instance,  in  South  Carolina,  when  you  go  into 
these  southern  colored  fields,  the  reports  show  11,2,  the  highest  number  we  have,  and 
Maryland  has  8.4? 

Dr.  Van  Ingen.  I  do  not  think  that  it  will  materially  affect  it,  sir,  because  the  rate 
for  native-born  white  women  being  7.4,  and  for  the  foreign-born  white  women  5.6, 
while  the  Negro  mortality  rate,  12.2,  only  brings  us  up  to  7.4;  even  without  the  influ- 
ence of  the  Negro  mortality,  I  do  not  think  Ave  will  move  up  much  in  that  scale. 

The  Chairman.  Can  you  tell  us  any  other  countries  •svith  which  you  are  comparing 
the  United  States  in  order  to  put  us  in  the  seventeenth  position? 

Dr.  Van  Ingen.  Yes;  England  and  Wales  have  stood  persistently  for  some  years  past 
between  three  and  four  per  thousand. 

The  Chairman.  And  the  others?  • 

Dr.  Van  Ingen.  I  can  not  give  you  the  others;  I  have  not  access  to  those  figures. 

Dr.  Baker.  Here  they  are  [handing  paper  to  Dr.  Van  Ingen]. 

Dr.  Van  Ingen.  Thefigm'es  show  for  Italv,  in  1915,  2.2;  Norway,  1915,  2.7;  Sweden, 

1915,  2.9;  The  Netherlands,  1919,  3.4;  Prussia,  1914,  3.5;  Japan,  1916,  3.5;  Finland, 

1916,  3.6;  Hungary,  1915,  4;  England  and  Wales,  1919,  4.4;  France,  1913,  4.6;  Aus- 
tralia, 1918,  4.7;  Ireland,  1918,  4.8;  New  Zealand,  1919,  5.1;  Spain,  1915,  5.2;  Switzer- 
land, 1915,  5.5;  Scotland,  1919,  6.2;  United  States  birth  registration  area,  1919,  7.4. 

The  Chairman.  Is  there  any  way  you  can  say,  for  the  benefit  of  the  record  and  the 
committee,  the  mortality  among  the  colored  women? 

Dr.  Van  Ingen.  No,  sir. 

Mr.  Graham.  Are  the  Canadian  figures  there? 

Dr.  Van  Ingen.  No,  sir;  Canada  is  CAidently  higher  than  ours.  The  reason  for 
that  I  could  not  say.  It  has  no  birth  registration.  The  figures  you  ask  for  are  the 
mortality 

The  Chairman.  Yes. 

Dr.  Van  Ingen.  From  all  causes  of  mortality  connected  with  childbirth,  among 
the  colored  people  in  the  birth  registration  area  this  is  12.2. 

The  Chairman.  In  the  birth  Registration  area? 

Dr.  Van  Inoen.  Yes;  those  are  the  only  figures  we  have. 

The  Chairman.  But  you  pick  the  cream  of  the  country. 

Dr.  Van  Ingen.  Those  are  the  only  figures  we  have. 

The  Chairman.  You  do  not  take  the  figures  where  the  colored  people  are  the  most 
numerous. 


32  PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY. 

Dr.  Van  Ingen.  No,  sir;  they  are  not  in  the  birth  registration  area. 

The  Chairman.  Is  there  no  way  of  finding  that  out? 

Dr.  Van  Ingen.  There  is  no  way  of  finding  that  out,  because  they  do  not  register 
their  births. 

The  Chairman.  If  the  figures  in  North  Carolina  are  to  be  taken,  and  some  of  the 
other  States  where  there  is  a  large  colored  population  that  percentage  would  be 
driven  up. 

Dr._  Van  Ingen.  The  7.4  has  nothing  to  do  with  any  part  of  the  country  except  in 
the  birth  registration  area. 

The  Chairman.  That  would  go  to  show  that  at  the  best  we  are  behind  all  these 
other  countries,  excepting  those  States  where  it  is  the  best. 

Dr.  Van  Ingen.  I  believe  these  figures  are  as  accurate  as  any  statistics.  In  the 
birth  registration  area,  in  the  22  States,  they  have  good  laws  which  they  enforce. 

The  Chairman.  So,  regardless  of  the  people  of  the  colored  race  and  the  southern 
part  of  the  country,  we  are  still  seventeenth? 

Dr.  Van  Ingen.  Yes. 

Mr.  Graham.  What  Southern  States  are  included  in  that? 

The  Chairman.  Whether  it  is  a  Southern  State  depends  somewhat  on  the  point  of 
view.  The  States  that  have  a  large  colored  population,  of  those  on  this  table,  I  think 
you  might  include  Maryland,  North  Carolina,  South  Carolina,  and  Virginia. 

Dr.  Van  Ingen.  Kentucky  has  a  fair  colored  population,  and  that  is  included  in 
that  birth  registration  area.     I  think  they  have  a  fairly  large  colored  population. 

Mr.  Graham.  Is  the  District  of  Columlaia  in  that? 

The  Chairman.  Yes.  The  District  of  Columbia  is  not  included  in  the  percentage; 
it  is  included  here,  but  not  taken  into  the  percentage. 

Dr.  Van  Ingen.  It  is  in  my  figure  of  7.4.  Mine  is  the  22  States  and  the  District 
of  Columbia,  the  entire  birth  registration  area.  The  figures  are  not  given  for  the 
cities  alone.     It  is  the  entire  State,  which  brings  in  the  rural  areas. 

Mr.  Lea.  Doctor,  what  reasons  can  you  assign  for  the  unfavorable  death  rate  in  the 
United  States? 

Dr.  Van  Ingen.  Which  kind  of  a  death  rate;  infant  mortality? 

Mr.  Lea.  Yes. 

Dr.  Van  Ingen.  You  mean  generally,  or — — ■ 

Mr.  Lea  (interposing).  I  mean  the  contrast  in  those  figures  you  have  just  presented 
between  our  country  and  foreign  countries. 

Dr.  Van  Ingen.  I  think  it  is  due  to  a  great  many  things.  I  think  one  of  them  is  the 
disgracefully  poor  obstetrical  care  which  our  mothers  get  in  the  rural  districts  and  in 
the  poorer  districts. 

Mr.  Graham.  Please  repeat  that,  Doctor;  I  did  not  hear  what  you  said. 

Dr.  Van  Ingen.  I  think  one  reason  is  the  very  bad  care  which  is  given  to  women 
at  the  time  of  childbirth  in  the  poorer  districts;  by  poorer  I  mean  the  more  scattered 
districts — in  the  small  towns  and  in  the  country.     I  think  that  is  one  reason. 

Mr.  Lea.  Would  these  statistics  indicate  that  mortality  is  higher  in  the  sparsely 
settled  districts  than  in  the  congested  districts? 

Dr.  Van  Ingen.  I  can  not  giA^e  you  that.  I  think  in  the  districts,  as  a  whole,  where 
you  have  not  the  congested  population  to  take  into  account  they  have  a  slightly  lower 
rate  than  they  have  in  the  larger  cities  where  there  is  much  congestion. 

Mr.  Lea.  There  must  be  some  good  reason  for  that  monumental  discrepancy. 

Dr.  Van  Ingen.  You  mean  between  ourselves  and  the  foreign  countries? 

Mr.  Lea.  Yes,  sir. 

Dr.  Van  Ingen.  Yes;  I  think  there  is.  The  midwife  is  a  very  large  factor  in 
obstetrical  work.  And  the  midwife,  on  the  other  side,  is  well  trained  in  her  work. 
In  this  country,  with  the  exception  of  a  very  few  States,  we  do  nothing  for  them;  we 
neglect  them. 

Mr.  Cooper.  Doctor,  is  it  not  a  fact  that  some  of  those  countries  which  have  a  lower 
infant-mortality  rate  have  already  organized  this  work,  having  begun  it  years  ago? 

Dr.  Van  Ingen.  They  have,  sir;  and  I  wanted  to  bring  that  out  in  what  I  was 
going  to  say  now. 

The  provisions  of  this  bill,  if  they  become  law,  are  not  an  experiment.  I  would 
not  believe  in  the  Government  spending  $1,500,000  on  an  experiment.  This  is  not 
an  experiment. 

Mr.  Cooper.  Doctor,  will  you  please  tell  us  what  Great  Britain  has  done  on  this  line? 

Dr.  Van  Ingen.  Yes;  Great  Britain  was  4.4  in  1920;  in  1917  it  was  practically  4- 
she  has  stayed  pretty  steadily  at  4  for  several  years. 

Mr.  Cooper.  What  are  they  doing  in  this  work,  I  mean? 

Dr.  Van  Ingen.  They  are  doing  a  very  great  deal,  sir.  They  have  a  similar  law 
to  this  law,  if  this  bill  should  become  a  law.     For  several  years  England  has  granted 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  33 

money  from  the  central  Government  to  local  communities  tfj  carry  out  child-life  plans 
provided  every  plan  was  approved  by  the  central  authority,  just  as  this  proposed  bill! 

Now,  as  an  example  of  the  stimulating  effect  of  this  law  upon  the  health  work  along 
that  line,  in  1917,  there  were  in  l^igland  and  Wales  1,1  (iS  maternal  and  child  welfare 
centers,  of  which  501  were  carried  on  l)y  olHcial  health  authorities.  In  1920— on  the 
Ist  of  January,  1920,  the  Ministry  of  Health  issued  a  list  of  maternity  and  child  welfare 
centers  of  England  and  Wales,  and  there  were  1,718  of  such  centers,  in  1,200  towns  and 
villages,  of  which  1,039,  or  nearly  twice  as  many  as  in  1917,  were  carried  on  by  local 
or  county  authorities.  In  1917  the  English  death  rate  among  babies  under  one  week 
of  age  was  23,  as  against  ours  of  30. 

Mr.  Cooper.  In  other  words,  after  England  had  experimented  with  this  work, 
they  went  ahead  and  increased  their  work? 

Dr,  Van  Ingen.  They  have  increased  their  work  so  enormously  that  in  1914  the 
Government  appropriated  11,000  pounds  on  exactly  the  conditions  that  this  bill 
provides. 

The  Chairman.  Eleven  thousand  pounds;  that  is  11,000  pounds  sterling,  at  what 
value  at  that  time? 

Dr.  Van  Ingen.  I  do  not  know,  sir.     But  England  increased 

The  Chairman  (interposing).  That  would  be  $55,000  would  it  not,  about? 

Dr.  Van  Ingen.  Yes,  sir. 

The  Chairman.  That  is  all  they  gave? 

Dr.  Van  Ingen.  That  was  in  1914. 

The  Chairman.  In  1914? 

Dr.  Van  Ingen.  Yes,  sir;  for  the  year  1918-19  the  English  Government  appro- 
priated over  200,000  pounds  for  these  same  purposes,  and  that  was  at  a  time  when 
England 's  financial  condition— I  think  everybody  will  concede  that  England's  finances 
were  very  low  at  that  time. 

Uv.  Cooper.  In  other  words,  the  English  Government  must  have  felt  that  it  was 
money  well  spent,  or  it  would  not  have  been  done? 

Dr.  Van  Ingen.  They  have  stated  in  their  publications  that  it  is  the  one  thing  that 
England  will  not  cut  down  on,  that  it  is  real  economy  for  England  to  spend  money 
for  that  purpose. 

The  Chairman.  Do  you  happen  to  know  the  constitution  of  the  board  or  agency 
that  has  charge  of  this  work?  * 

Dr.  Van  Ingen.  You  mean  in  England? 

The  Chairman.  Y'es. 

Dr.  Van  Ingen.  Before  the  reorganization  of  the  work  into  the  ministry  of  health, 
the  plan  was  approved  by  the  medical  officer  of  the  local  government  board. 

The  Chairman.  I  mean  for  the  general  government. 

Dr.  Van  Ingen.  They  are  part  of  the  general  government  and  were  the  reviewing 
authority.  They  had  a  medical  officer  of  the  local  government  board.  This  medical 
officer  was  Sir  Arthur  Newsholme. 

The  Chairman.  So  it  rests  in  the  hands  of  the  central  government? 

Dr.  Van  Ingen.  Y"es.  It  is  now  the  duty  of  the  ministry  of  health  to  pass  on  the 
plan. 

The  Chairman.  Subject  to  the  inspiration  and  direction  from  the  medical  sources 
representing  the  Government? 

Dr.  Van  Ingen.  The  plan  is  submitted  by  local  authorities  to  the  central  govern- 
ment, and  the  central  government  says,  "You  raise  the  money  necessary,  and  we  will 
approve  your  plan . " 

The  Chairman.  Who  represents  the  Government  in  so  doing? 

Dr.  Van  Ingen.  I  think  Sir  George  Newman. 

The  Chairman.  Have  they  ever  had  any  other  medical  man  in  charge  of  that 
work? 

Dr.  Van  Ingen.  At  the  head  of  it? 

The  Chairman.  At  the  head  of  it,  or  in  it? 

Dr.  Van  Ingen.  The  reviewing  authority  since  that  law  was  passed  was  first  Sir 
Arthur  Newsholme  and  then  Sir  George  Newman. 

Mr.  SWeet.  It  is  purely  advisory  as  to  accepting  the  benefits  of  the  act,  by  this 
reviewing  authority? 

Dr.  Van  Ingen.  Yes;  exactly  the  same  as  our  Children's  Bureau. 

Mr.  Sweet.  And  not  administrative  in  any  way? 

Dr.  Van  Ingen.  No,  sir;  except  that  they  have  got  to  show  that  they  will  do  what 
they  promise  to  do.  It  is  just  like  our  bill.  There  is  no  authority  over  the  State 
health  department,  except  to  make  them  do  what  they  said  they  would  do. 

Mr.  Sweet.  And  the  work  was  voluntary,  so  far  as  its  acceptance  was  concerned? 

Dr.  Van  Ingen.  Yes,  sir. 

74654—21 3 


34  PUBLIC   PROTECTION    OP   MATEKJSriTY  AND   USTPAISTCY. 

Mr.  Sweet.  They  could  either  accept  it  or  reject  it? 

Dr.  Van  Ingen.  Yes,  sir. 

Mr.  Sweet.  And  the  law  has  worked  well,  you  say? 

Dr.  Van  Ingen.  Everybody  in  England  says  that  it  has  done  more  to  improve 
conditions  in  England  than  anything  that  has  been  done  in  the  past  10  or  15  years. 

Mr.  Sweet.  And  you  say  in  the  last  fiscal  year  they  appropriated  £200,000? 

Dr.  Van  Ingen.  That  was  for  the  fiscal  year  1918-19. 

Mr.  Sweet.  Two  years? 

Dr.  Van  Ingen.  No;  the  fiscal  year  1918-1919.  Their  fiscal  year  overlaps  the 
calendar  year.  I  do  not  have  the  figures  for  1919,  as  I  have  not  seen  them  yet,  but 
they  have  steadily  gone  up  in  their  appropriations.  [Referring  to  book  handed  by 
some  person  in  the  room.]  I  see  here  that  the  total  grant  to  be  paid  to  the  local  author- 
ities during  the  year  ended  March  1  was  £526,217;  it  has  gone  up  from  £11,000. 

The  Chairman.  If  you  translate  that  into  American  money,  it  would  mean  about 
$2,000,000? 

Dr.  Van  Ingen.  Yes;  that  is,  roughly  speaking. 

There  is  one  other  matter  that  I  would  like  to  mention,  that  has  a  bearing  on  the 
efficiency  of  this  kind  of  work.  The  last  figures  that  I  know  of  on  that  subject  are 
being  compiled  by  the  Maternity  Center  Association  of  New  York.  This  association, 
during  1920,  cared  for  over  11,000  mothers  and  their  babies  at  the  maternity  centers, 
25  in  number,  through  its  staff  of  doctors  and  nurses.  Patients  made  25,102  visits  to 
the  cl^inics,  and  63,488  visits  were  made  to  the  homes  by  the  nurses,  where  they  taught 
the  mothers  in  their  own  hoines  to  take  care  of  their  babies,  and  the  work  was  done 
by  well- trained  nurses. 

Figures  on  this  subject  are  also  being  compiled  by  Dr.  Louis  I.  Dublin,  of  the 
Metropolitan  Life  Insurance  Co.,  and  Dr.  Dublin  has  given  out  a  statement  to  the 
effect  that  the  death  rate  amoz\g  mothers  due  to  causes  connected  with  childbii'th  has 
been  reduced  two  thirds ;  and  the  deaths  among  children  under  one  month  of  age  was 
one  half,  and  the  still  births  also  one  half,  compared  with  the  rates  which  prevailed  in 
the  borough  of  Manhattan  for  the  same  period. 

Mr.  Cooper.  This  work  was  all  voluntary  on  the  part  of  the  mothers? 

Dr.  Van  Ingen.  Absolutely.     This  is  a  voluntary  organization. 
V  Mr.  Cooper.  It  has  been  intimated  around  in  various  quarters — and  I  have  read  the 
hearings  before  the  Senate — that  this  bill  contemplates  compulsory  medical  attention ; 
do  you  find  anything  of  the  kind  in  this  bill? 

Dr.  Van  Ingen.  Mr.  Cooper,  there  is  absolutely  nothing  that  I  can  see  of  that  kind 
in  the  bill,  and  I  do  not  see  how  it  can  be  read  into  the  bill.  In  the  first  place,  it  is  not 
the  National  Governmsnt's  fault  if  it  is.  The  Government  has  nothing  to  do  with  it. 
It  puts  it  up  to  the  State  and  the  divisions  of  child  hygiene  to  work  out  that  point, 
and  they  have  absolutely  no  authority  to  do  anything  of  this  kind.  It  is  an  offer  pure 
and  simple,  and  nothing  else. 

The  Metropolitan  Life  Insm'ance  Co. — and  I  have  never  heard  of  an  insurance 
company  being  accused  of  having  altruistic  motives  of  spending  money — the  Metro- 
politan Life  Insurance  Co.  considered  this  matter  years  ago  of  preventing  infant 
deaths  and  they  started  to  work  on  the  matter,  and  to-day  their  work  is  so  valuable  in 
its  beneficial  effects  that  the  insurance  company  has  made  arrangements  in  nearly  all ' 
of  the  cities  in  which  there  are  visiting  nursing  agencies  for  a  nurse  from  the  visiting 
nurse  associations,  to  do  nursing  service  for  their  policy  holders,  if  the  mother  is 
willing  to  receive  her  help.  They  provide  nursing  for  the  mother  before  and  after 
confinement  to  their  insured  women,  and  every  insured  woman  is  entitled  to  four 
visits  from  the  nurse.  The  company  has  increased  its  expenditures  along  that  line 
during  the  last  year  very  greatly. 

The  Chairman.  Do  they  do  that  for  all  of  their  policy  holders? 

Dr.  Van  Ingen.  When  they  are  sick. 

The  Chairman.  Do  they  not  provide  means  of  visiting  their  policy  holders;  doing 
a  sort  of  social  service  work? 

Dr.  Van  Ingen.  I  do  not  think  they  are  sending  any  nurses  to  people  who  are 
apparently  well,  with  the  exception  of  the  prenatal  cases,  and  there  the  expectant 
mother  is  entitled  to  two  visits  before  labor  by  the  niu"se. 

The  Chairman.  They  are  doing  considerable  work  of  that  kind. 

Dr.  Van  Ingen.  Yes;  and  they  consider  that  it  is  a  matter  that  is  well  worth  spend- 
ing money  on. 

Dr.  Graham.  Doctor,  to  recur  to  these  figures  just  a  moment.  The  second  page  of 
this  table  gives  the  figures  of  the  death  rates  from  causes  connected  with  childbirth 
per  thousand  living  births  in  cities  of  over  100,000  population,  and  in  that  table  New 
York  City  is  given;  in  1915  the  rate  was  5.6,  while  in  1919  it  was  5.7.  I  do  not  remem- 
ber whether  Dr.  Baker  mentioned  that  proposition  or  not;  I  gathered,  however,  in  a 
general  way,  from  what  she  said  that  the  death  rate  had  decreased  in  New  York  City. 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  35 

Dr.  Van  Inoen.  Not  from  that  cause. 

Dr.  Baker.  What  cause? 

Dr.  Van-  Inc. en-.  ]\ratorual  deaths  per  thousaufl  birth.s  has  not  decrca.scd. 

Dr.  liAKEu.  Oh,  a  great  deal. 

Dr.  Van  Ingen.  In  the  last  five  years? 

Dr.  Baker.  In  the  last  five  years  the  deaths  from  puerperal  causes  has  shown  a 
very  marked  decrease,  and  is  now  lower  than  any  of  the  American  cities,  and  I  In- 
European  cities  in  Dr.  Howard's  report. 

Dr.  Van  Inc. en.  That  statement  is  different  from  mine;  I  was  speaking  of  the  two 
major  causes  of  death,  the  one  that  used  to  be  known  as  the  Ivinjj-in  fever,  oi-  blood 
poison 

Dr.  Baker  (interposing).  ]\Iaternal  mortality,  as  I  was  speaking  of  it  in  Xcw  York 
City,  is  divided  by  Dr.  Howard,  and  cenerally  divided  by  all  authorities,  into  the 
total  maternity  mortality  and  the  maternal  mortality  on  account  of  puerjieral  di.^ea.ies. 
The  total  maternal  deaths  can  only  show  a  marked  reduction  as  you  reduce  the  deaths 
from  puerperal  causes.     Those  have  been  reduced  very  materially. 

Mr.  Graham.  As  a  matter  of  fact,  Doctor,  the  total  mortality  percentage  has 
increased?  '"^ 

Dr.  Baker.  My  understanding  is  the  total  mortality,  in  10  years,  has  decreased. 

Mr.  (.TitAHAAi.  From  1910  to  1915,  it  is  shown  by  the  doctor's  statement  here,  an<l 
I  notice  there  is  an  increase  in  the  years  191.5  to  1919  both  in  New  York  State  and  in 
the  city  of  New  York. 

Dr.  Baker.  The  maternal  mortality  has  increased? 

Mr.  Graham.  As  shown  by  these  figures. 

Dr.  Baker.  That  probably  includes  maternal  mortality  due  to  influenza  and  not 
strictly  to  the  accidents  and  diseases  of  childbirth.  1  think  you  will  find  by  studies 
made  b\-  the  Children's  Bureau  and  Dr.  Howard's  report  and  our  own  figures  the 
maternal  mortality  from  preventable  causes  has  shown  a  marked  decrease,  and  it  is 
the  only  city-in  the  United  States  that  has  shown  that  decrease.  But  in  the  last  two 
years  the  total  maternal  death  rate  has  gone  up  on  account  of  the  influenza.  l)ut  there 
was  an  increase  in  the  death  rate  during  those  years  of  deaths  of  both  sexes  and  at 
all  ages. 

_    Mr.  Graham.  These  figures  submitted. by  the  doctor  show  that  in  1915  it  was  5.G; 
in  1916,  5.3;  in  1917,  5.1,  a  gradual  decrease;  then  in  1918  it  was  7.?.,  and  in  1919,  5.7. 

Dr.  Baker,  'ihose  were  the  influenza  years,  which  increased  the  death  rates  at 
all  ages.  If  you  will  take  the  10-year  period  and  compare  last  year  with  10  vears  ago, 
1  think  }-ou  will  see  there  is  a  marked  decrease  in  the  maternal  mortality  rate. 

}h\  Graham.  I  thought  that  inasmuch  as  these  figures  were  apparently  in  conflict 
with  your  statement  it  should  be  cleared  up. 

Dr.  Baker.  There  were  a  great  many  deaths  among  the  mothers  due  to  influenza, 
a  disease  that  attacked  everybody.  But  in  cases  actually  connected  with  childbirth, 
there  has  been  a  decrease  in  the  last  10  years,  if  you  will  exclude  intiuenza.  a  disease 
that  attacked  everybody  of  all  ages  and'  both  sexes. 

Dr.  Van  I.ngen.  If  I  may  proceed,  Mr.  Chairman,  I  want  to  speak  for  a  moment  as 
a  physician.  A  great  deal  has  been  said  as  to  what  is  the  attitude  of  the  profession 
toward  this  bill,  and  what  the  attitude  of  the  profession  will  be  toward  the  bill.  I 
have  heard  it  said  that  doctors  are  against  it.  In  defense  of  the  doctors  1  want  to  say 
a  word.  Doctors  are  very  conservative,  and  it  is  fortunate  for  the  community  that 
they  are.  The  doctors  want  to  understand  the  proposition,  and  doctors  who  practice 
obstetrics  will  not  approve  proposals  of  this  kind  until  they  have  investigated,  but 
they  are  skeptical.  1  think  the  medical  profession  must  have  been  originated  in 
Missouri,  because  you  have  always  got  to  show  a  doctor  before  he  will  accept  anvthing. 

I  want  to  quote,  if  I  may,  from  the  hearing  before  the  Senate  Committee  on" Public 
Eealth  and  National  Quarantine  in  the  Sixty-sixth  Congress,  when  Dr.  J.  AMiitridge 
Williams  was  before  the  comm,ittee.  and  he  was  asked  by  Senator  Ransdell: 

■'Senator  Ransdell.  Doctor,  do  you  feel  you  are  speaking  for  your  profession  very 
generally  in  advocating  the  passage'of  this  bill? 

"Dr.  Williams,  I  can  not  quite  say  that,  but  I  imagine  that  I  am  speaking  for 
everyone  that  understands  the  problem.  Many  doctors  do  not  understand'it  because 
;hey  have  had  a  very  poor  training  in  obstetrics,  and  regard  childbirth  as  a  normal 
unction  which  should  require  very  little  attention.  It  is  evident,  however,  from 
yhat  I  have  said  that  such  is  not  .the  case.  That  large  numbers  of  won  en  have  had 
I  great  deal  of  trouble,  that  every  year  unnecessarily  large  numbers  of  women  and 
jhildren  are  lost,  and  that  we  have  an  amount  of  invalidism  which  is  altogether  pre- 
ventable. 

"Senator  Ransdell.  Would  there  be  any  antagonism  on  the  part  of  the  ordinarv 
loctor  toward  it? 


36  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

"Dr.  Williams.  I  think  the  ordinary  doctor  would  welcome  it." 
Speaking  as  a  physician,  and  I  know  something  about  what  the  attitude  of  the 
physicians  is  toward  this  kind  Of  work — -I  have  had  a  considerable  amount  of  practical 
experience  in  my  so-called  leisure  time  in  trying  to  help  organize  and  supervise 
definite  practical  pieces  of  work  that  have  been  done  for  helping  the  community, 
especially  the  children  and  mothers.  I  have  been  connected  with  two  or  three  of 
those  things  in  New  York.  I  was  in  the  work  for  demonstrating  the  value  of  infant 
welfare  centers,  which  has  led  up  to  Dr.  Baker  securing  her  appropriation  for  the 
carrying  on  of  her  work  in  this  line.  Of  course,  we  worked  with  the  health  depart- 
ment. I  have  been  connected  with  the  work  of  maternity  center  avocation,  and  I 
have  seen  the  attitude  personally  and  practically  of  the  doctors  in  the  poorer  parts 
of  our  city. 

At  first  they  are  skeptical;  at. first  they  do  not  welcome  it.  When  a  new  center 
is  opened  up,  that  is  exactly  the  type  of  place  where  this  question  will  come  up. 
We  have  25  centers  under  the  maternity  center  association.  The  first  thing  we  do 
when  we  go  into  a  center  is  to  get  in  touch  with  the  doctors.  We  explain  to  them 
our  methods  of  work,  and  explain  it  to  them  that  we  try  to  keep  their  patients  well; 
that  our  work  has  nothing  to  do  with  their  confinement,  and  is  not  for  the  purpose 
of  taking  away  their  legitimate  work.  And  we  have  hardly  had  a  single  doctor  who 
has  not  allowed  us  to  visit  his  patients,  and  almost  every  one  has  allowed  us  to  go 
in  and  watch  his  patients  after  his  first  experience  with  us.  We  have  not  had  any 
doctor  who  has  refused  to  work  with  us  after  we  have  gotten  hold  of  his  patients, 
and  who  has  not  continued  to  work  with  us.  And  many  of  our  patients  now  who 
come  into  our  centers  are  sent  in  by  their  doctors  to  be  watched  and  cared  for  during 
pregnancy,  and  until  they  are  confined.  That  is  the  attitude  of  the  doctors.  The 
same  was  true  of  the  welfare  stations;  we  have  shown  the  doctors  that  we  desire  to 
cooperate  with  them;  that  it  is  not  something  that  is  not  going  to  give  him  more 
duties  and  more  responsibilities  and  cut  down  his  work  which  he  is  entitled  to,  and 
he  cooperates  with  us.  I  think  you  are  going  to  find  the  opposition  an  the  part  of 
the  doctors  is  going  to  be  very,  very  small — short-lived.  _ 

Another  thing  has  been  brought  up  that  I  have  heard;  it  has  been  mentioned  here 
two  or  three  times  to-day,  and  that  is  whether  the  Children's  Bureau  is  the  proper 
bureau  to  administer  this  law.  I  speak  as  one  who  has  had  a  little  experience  in 
trying  to  work  out  the  practical  details  of  this  matter.  The  Children's  Bureau  is 
not  a  laymen's  bureau,  so  far  as  the  personnel  is  concerned.  The  director  of  hygiene 
of  the  bureau  is  a  licensed  physician,  and  an  obstetrician  of  considerable  experience,  I 
a  physician  who  was  in*  charge  of  an  obstetrical  hospital  in  California  for  several  I 
years  before  he  came  here,  and  just  before  coming  here  performed  two  of  the  most 
difficult  operations  in  obstetrics.  There  are  several  other  doctors  in  that  bureau 
whose  services  are  available.  I  want  to  say,  as  a  doctor,  that  I  personally  do  not 
think  that  the  proper  persons  to  work  out  the  details  of  an  educational  campaign 
are  doctors.  To  start  with,  this  is  a  proposition  for  people  who  have  had  social 
experience,  and  who  know  how  to  organize  an  educational  campaign.  The  doctors 
are  wanted;  their  advice  should  be  asked;  they  should  pass  upon  the  merits  of  the 
plans.  The  working  out  of  the  plan  will  be  for  those  with  social  experience.  The 
things  that  are  going  to  be  necessary  to  be  done  should  be  done  by  those  with  such 
experience.  They  will  require  special  methods  to  meet  special  needs.  It  will  be 
necessary  to  work  it  out  differently  in  different  parts  of  the  country.  It  is  going  to 
be  different,  for  instance,  where  you  have  a  large  Negro  population.  But  the  prin- 
ciples are  the  same,  and  the  principles  are  pretty  definitely  worked  out  right  now 
as  to  what  kind  of  work  this  will  be  when  it  gets  started.  I  do  not  feel  that  the 
Children's  Bureau  is  disqualified  because  it  has  a  few  lay'members  on  it. 

Mr.  Newton.  You  referred  to  a  person  who  is  now  with  the  Children's  Bureau  as 
the  director  of  hygiene? 

Dr.  Van  Ingen.  Yes,  sir. 

Mr.  Newton.  What  is  the  name  of  that  individual? 

Dr.  Van  Ingen.  Dr.  Anna  Rude. 

Mr.  Newton.  How  long  has  she  been  with  the  bureau? 

Dr.  Van  Ingen.  Four  years. 

I  want  to  say  just  two  things  more:  Judge  Towner  spoke  when  this  hearing  was 
opened  yesterday  about  ignorance  as  being  one  of  the  great  causes  of  this  condition. 
It  is  a  fact,  as  can  be  attested  by  those  who  have  watched  it,  that  the  three  great  causes 
in  the  majority  of  cases  of  deaths  of  mothers  and  babies  are  due  to  poverty,  bad  housing.J 
and  ignorance,  and  the  greatest  of  these  is  ignorance. 

The  chairman  spoke  of  the  needs  of  economy,  and  the  efforts  of  the  Government  tc 
economize.     There  is  such  a  thing,  I  believe,  as  extravagant  economy.     In  the  United 


1 
1 
I 

tie 
avai 


PUBLIC   PROTECTION   OF   MATERNITY   AND  INFANCY.  37 

vStates  of  America,  if  these  figures  are  correct,  and  I  say  nobody  can  question  them, 
12,000  mothers  died  in  one  year,  and  28,500  babies  nnder  1  month  of  age  died 

Mr.  Sweet  (interposing).  Right  in  that  connection,  Doctor,  1  want  to  ask  you  a 
question.  Under  ])roper  care  and  i)roper  treatment,  how  many  of  tliose  mothers,  and 
how  many  of  those  babies  could  have  been  saved? 

Dr.  Van  Inoen.  According  to  ex])erience  among  11,000  mothers  in  the  maternity 
centers — and  exactly  the  same  kind  of  thing  can  be  done  by  the  help  ])rovided  for  in 
this  bill — fidly  two-thirds  t)f  the  maternal  mortality  were  prevented ;  one-half  of  the 
deaths  among'the  children  under  1  month  of  age,  and  one-half  of  the  stillbirths. 

Mr.  Sweet.  Give  me  your  opinion,  as  a  doctor,  without  referring  definitely  to  any 
figures,  what  percentage  of  mothers  and  babies  could  have  been  saved,  as  you  view  it? 

Dr.  Van  Incen.  Among  the  group  who  could  be  reached,  I  believe  that  you  can 
save  50  per  cent  of  the  mothers  and  babies. 

Mr.  Cooper.  Do  you  believe,  Doctor,  that  the  social  part  of  the  child  welfare  work 
is  about  as  important  a;s  the  medical  side  of  it? 
,      Dr.  Van  Ingen.  I  do;  yes,  sir. 
[      Mr.  Cooper.  And  that  is  a  work  that  this  bill  contemplates,  is  it  not? 

Dr.  Van  Ingen.  Yes,  sir. 

Mr.  Cooper.  The  social  work,  or  field  work? 

Dr.  Van  Ingen.  The  educational  work,  I  consider,  is  oO  per  cent  of  our  battle. 
We  have  had  examples  of  that  over  and  over  again.  Until  we  began  to  resort  to  edu- 
cational means  in  reducing  oiu'  infant  mortality  in  the  various  cities — and  J  ana  sure 
Dr.  Baker  will  bear  me  out  on  that — we  did  something,  but  it  is  the  prevention  of 
sickness,  and  the  prevention  of  death  following  sickness,  rather  than  the  treatment 
of  sickness  that  is  the  most  important  thing  to-day,  and  that  is  the  means  by  which  we 
are  going  to  accomplish  something.  And  I  consider  the  saving  of  the  lives  of  these 
babies,  and  the  saving  of  the  lives  of  12,000  mothers — I  have  never  figured  out  how 
much  each  life  is  worth — but  I  figure  a  million  and  a  half  dollars  spent  by  the  United 
States  Government  for  that  purpose  would  be  money  very  wisely  spent. 

I  have  taken  the  liberty  to  bring  with  me  a  few  statistical  reports  of  infant  mor- 
tality for  1920  in  519  cities  of  the  United  States.  They  are  here,  if  any  of  the  members 
of  the  committee  desire  to  have  them.  These  figures  are  in  tabular  form.  These 
figures  have  been  prepared  by  the  American  Child  Hygiene  Associations  from  519 
cities.  They  are  all  based  on  local  reports,  not  on  the  Census  Bureau  reports,  because 
they  are  not  out  as  yet.  The  figures  in  heavy-faced  type  in  the  report  referred  to 
are  from  the  official  Census  Bureau  reports,  and  those  in  the  light-faced  type  are 
from  the  local  health  authorities. 

Mr.  Barkley.  Doctor,  there  appeared  before  this  committee  in  the  last  Congress, 
and  may  appear  again  in  opposition  to  this  bill  the  representative  of  a  society  in 
New  York  known  as  the  Citizens'  Medical  Reference  Bureau.  I  do  not  know  that 
you  care  to  give  any  opinion  as  to  the  standing  of  that  bureau,  or  what  it  is,  but  if 
you  can  give  me  any  information  on  that,  I  would  be  glad  to  have  it. 

Dr.  Van  Ingen.  I  think  you  will  find  very  few  men  in  New  York  who  know  any- 
thing about  it.  It  is  nothing  in  the  way  of  a  medical  organization.  I  never  heard 
of  it  until  I  saw  it  referred  to  in  the  testimony  to  which  you  refer.  It  is  not  one  that 
has  the  least  standing  as  a  medical  society  in  New  York.  You  have  asked  me  for 
my  personal  opinion,  and  that  is  my  opinion. 
I  Mr.  Barkley.  Do  you  know  anything  about  the  New  York  A nti- Vivisection  So- 
I  ciety,  or  the  Society  of  Anti-Vivisection? 

I      Dr.  Van  Ingen.  That  is  like  shaking  a  red  rag  at  a  bull.     I  do  not  know  them 

i  personally,  but  I  know  them  to  be  a  group  who  are  doing  their  level  best  in  the  in- 

;  terest  of  saving  the  lives  of  a  few  dogs  to  prevent  the  doctors  carrying  on  experiments 

1  to  develop  means  of  saving  human  life,  such  as  the  transfusion  of  blood,  which  is 

one  of  the  most  striking  examples  of  experimental  work  upon  animals.     They  are  an 

association  which  is  opposed  to  allowing  medical  colleges  and  schools  of  research  to 

use  dogs,  at  any  rate,  for  their  experimental  purposes. 

Mr.  Barkley.  Doctor,  as  a  physician,  would  you  give  me  your  opinion  as  to  whether 
the  provisions  of  this  bill  have  the  remotest  connection  with  vivisection? 

Dr.  Vav  Ingen.  No,  sir;  I  fail  to  see  how  there  is  any  connection  between  the  two. 

Mr.  Newton.  This  society,  most  of  them,  are  opposed  to  the  use  of  any  animals  for 
experimental  purposes,  are  they  not? 

Dr.  Van  Ingen.  I  think  probably  they  are. 

Mr.  Newton.  From  the  dog  down  to  the  guinea  pig? 

Dr.  Van  Ingen.  I  think  probably  that  is  true.  But  I  notice  they  are  opposed  to 
the  use  of  the  dog  particularly,  because  the  dog  is  practically  the  only  animal  that  is 
available  for  certain  experiments. 


38 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY. 


Mr.  Chairman,  I  have  here  the  infant  mortality  rates  for  the  United  States  in  the 
birth  registration  area  for  the  years  1915,  1916,  1917,  1918,  and  1919,  showing  the 
rates  under  1  year,  under  1  month,  and  under  1  week  for  those  various  years;  also 
the  infant  mortality  rate  for  England  and  Wales  at  the  same  ages  for  the  years  1915, 
1916,  and  1917;  also  for  Australia,  for  the  same  ages  for  the  years  1917,  and  1919; 
and  for  New  Zealmd  at  the  same  ages  for  the  year  1917;  also  the  death  rates  from 
puerperal  causes  per  1,000  live  births  in  the  birth  registration  area  for  various  cities 
for  the  years  1915,  1916,  1917,  1918,  and  1919;  also  the  statistics  of  infant  morta  i1y 
for  Engiand  and  Wales  for  the  years  1911  to  1917,  inclusive,  showing  the  deaths  under 
1  month,  under  1  year,  which  I  would  like,  if  agreeable  to  the  committee,  to  have 
inserted  in  the  record  with  my  remarks. 

The  Chairman.  Without  objection,  they  will  be  inserted  in  the  record. 

(The  tables  so  referred  to  are  here  printed  in  full,  as  follows:) 

Infant  mortality  rates — Birth  registration  area. 


Under  1 
year. 

Under  1 
month. 

Under  1 
week 

1915 

UNITED  STATES. 

100 
101 
94 
101 

87 

110 
91 

97 

56 

44 
44 
43 
44 
41 

38 
37 
37 

29 

30 

1916       .                  

30 

1917 I 

30 

1918 

31 

1919                                        ,       .   .   

29 

1915 

ENGLAND  AND  WALES. 

23 

1916 

23 

1917                                           .,.   

24 

1917 

AUSTRALIA. 

21 

1918 

1919                                                            - 

69 

48 

34 

28 

25 

1917 

NEW  ZEALAND. 

Death  rates  from  puerperal  causes  per  1,000  live  births — Birth  registration  area. 


Area. 

Washing- 
ton, D.C. 

New 
York. 

Boston. 

1915 

6.1 
6.2 
6.6 
9.2 
7.4 

7.0 

10.1 

8.5 

9.1 

8.5 

5.6 
5.3 
5.1 
7.3 
5.7 

8.3 

191G 

7.1 

1917 

9.1 

1918 

11.6 

1919 

9.1 

Boston  rate:  Of  37  cities  over  100,000  only  8  had  higher  record  and  3  as  had  as  Boston  in  1919. 


States. 

1915 

1916 

1917 

1918 

1919 

Massachusetts 

5.7 
5.9 

6.0 
5.4 

6.5 
5.7 

9.2 
8.0 

7.1 

New  York 

6.2 

PUBLIC   PROTECTION    OF    MATERNITY   ^td   infaNCY.  39 

Staiistics  of  ill/tint  morUdity,  England  ui  Wales. 


1911 
1912 
1913 
1914 
1915 
1910 
1917 


Infant  mortality- 

Doaths 

'oaths 

rate. 

iidcr 

1  nioiilh. 

'car. 

Under 

Under 

1  month. 

1  year. 

Per  cent. 

Per  cent. 

35,817 

ll:ho 

41 

130 

33,547 

82,n 

38 

95 

34, 7X1 

95, ; 

39 

108 

33,815 

91, i) 

38 

105 

30, 867 

89,3.' 

38 

110 

28,979 

71,6^ 

37 

91 

25,044 

64,48b            37 

96 

The  Ch.\irman.  Are  there  any  other  questions?  If  not,  you  w.  be  excused, 
Doctor,  and  we  are  very  much  obliged  to  you. 

The  committee  will  now  stand  adjourned  until  10  o'clock  to-morrow-iornin<?. 

(And  thereupon,  at  12  o'clock  and  10  minutes  p.  m.,  the  committet-Kjjourne'i  to 
meet  on  Thursday,  July  14,  1921,  at  10  o'clock  a.  m.)  .      • 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives 

Thursday,  July  14,  lc>j_ 

The  committee  met  at  10.15  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairLr^) 
presiding. 

The  Chairman.  The  committee  will  be  in  order.     Mr.  Towner,  when  you  are  reac^^ 
we  "will  proceed. 

Mr.  Towner.  I  am  requested  by  Felix  Cordova  Davila,  the  Resident  Commis- 
sioner of  Porto  Rico,  to  present  this  statement,  which  may  be  placed  in  the  record 
with  your  consent,  asking  that  the  law  be  extended  to  Porto  Rico.  I  ask  that  it  be 
printed  in  the  record. 

The  Chairman.  If  it  is  agreeable  to  you,  Judge,  such  documents  as  this  which  you 
may  hand  to  the  Chair  will  be  read  at  the  end  of  the  presentation  of  your  side,  so  that 
it  may  be  embodied  in  the  record  at  that  place. 

]Mr.  Towner.  Any  arrangement  that  i* satisfactory  to  the  committee  is  satisfactory 
to  me. 

Mr.  Rayburn.  Before  we  proceed  I  would  like  to  determine  the  policy  of  the  com- 
mittee. Is  it  the  intention  of  the  committee  to  sit  after  11  o'clock  after  to-day  or 
to-moiTow,  when  the  tariff  bill  will  be  under  the  five-minute  rule? 

The  ( 'hairman.  That  question  may  well  be  brought  up  at  this  time. 

Mr.  Rayburn.  My  understanding  was  that  we  would  not  try  to  sit  during  the  ses- 
sions of  the  House.  I  was  detained  yesterday,  but  I  would  like  to  be  here  and  hear 
this  testimony.  But  I  must  be  on  the  floor  of  the  House  during  the  consideration 
of  the  bill.  I  thought  the  decision  the  other  day  was  that  we  would  not  sit  during 
the  sessions  of  the  House. 

The  Chairman.  That  is  quite  true,  but  the  observance  of  it  has  been  rather 
neglected. 

Mr.  Rayburn.  I  move  that  it  be  the  sense  of  the  committee  that  we  do  not  sit 
during  the  sessions  of  the  House. 

The  Chairman.  The  committee  has  heard  the  suggestion  of  Mr.  Rayburn.  Are 
there  any  remarks? 

Mr.  Graham.  Mav  I  suggest  to  I\Ir.  Ravburn  a  modification  of  that,  making  it  after 
to-day?  .... 

Mr.  Rayburn.  Well,  I  am  interested  in  this  matter  to-day,  because  I  want  some  time 
if  I  can  possibly  get  it. 

Mr.  Graham.  I  think  in  that  case  you  are  entirely  right,  then. 

Mr.  Rayburn.  I  think  the  committee  ought  at  an  early  date  to  determine  about 
bringing  these  hearings  to  a  close  and  providing  time  for  the  opponents  and  the  pro- 
ponents of  the  measure.  I  think  we  could  prolong  these  hearings  all  summer  and 
probably  not  get  much  more  information  than  if  each  side  would  designate  six  or 
eight  people  to  present  their  case  entirely  to  the  committee. 


40  PUBLIC   PROTfTTO^   OF   MATERNITY  AND   USTFANCY. 

The  Chairman.  Shall  wfake  the  sense  of  the  committee  now  upon  that?     If  there 
are  no  further  remarks,  tl/'hair  will  ask  all  those  members  who  are  in  favor  of  bring- 
ing this  hearing  this  m'orj^°'  to  ^  close  at  11  o'clock  to  manifest  it  by  a  show  of  hands. 
Mr.  Mapes.  Mr.  Chai/an>  I  think  it  is  essential  that  we  deterinine  what  we  are 
going  to  do  while  this  t/^  measure  is  under  the  5-niinute  rule. 

The  Chairman.  If  tf®  i^  ^'^  objection,  the  Chair  will  include  all  the  time  from 
now  to  and  including  P  21st  of  July. 

Mr.  Mapes.  So  far  M  ^^^  concerned,  I  would  just  as  soon  sit  a  little  while  longer 
to-day,  but  it  does  njf  ©em  to  me  that  we  can  under  that  five-minute  rule. 

The  Chairman.  Wh  the  understanding  that  the  suggestion  of  limitation  of  the 
hour  of  session  is  t/i^clude  all  the  time  up  to  and  including  the  21st  of  July,  the 
Chair  will  ask  thosA"^oring  the  idea  of  adjourning  at  11  o'clock  each  day  to  manifest 
it  by  a  show  of  ha/^- 

(the  motion  w^^t  and  carried.) 

The  CHAiRMAt/The  preponderance  of  opinion  appears  to  be  in  favor  of  adjourning 
at  11  o'clock,  aiVit  will  be  so  understood. 

Mr.  Hawe's.  A-  Chairman,  it  is  quite  apparent  that  we  have  witnesses  here  from 
all  over  the  lyted  States,  and  if  this  hearing  drags,  these  witnesses  will  have  to 
remain  for  a  p/od  of  10  days  in  order  to  testify  for  only  a  period  of  20  minutes.  We 
should  have  a/^rangement  for  nighf  sessions,  so  that  they  can  be  taken  care  of.  There 
is  a, witness  n^  from  my  State  that  at  the  rate  we  are  going  could  not  be  heard  for  a 
week.~"f-t-isAher  expensive  staying  in  Washington. 

Mr.  Map"*-  ■'^^-  Chairman,  is  it  possible  for  Judge  Towner  or  somebody  in  charge 
of  the  he/^S^  ^^^  *^®  proponents  to  arrange  to  have  those  heard  who  are  the  most 
inconve^^^®*^  ^y  staying  here? 

Mr.  ^wisEE.  1  will  say  to  the  gentleman  that  that  is  what  we  have  been  trying  to 
do,  SO''"  as  our  witnesses  are  concerned. 

M^./Lea.  Mr.  Chairman,  I  would  suggest  that  we  try  to  make  some  arrangement 
abo/  limiting  the  time.  So  far  as  I  am  concerned  I  think  that  this  matter  ought  to 
be/resented  within  a  few  hours  for  each  side,  and  if  the  opponents  and  proponents  of 
tj^  matter  could  agree  on  it,  I  believe  it  would  facilitate  an  early  disposal  of  the 
fatter.  I  think  that  the  committee  could  get  sufficient  inforpaation  on  each  side  in 
A  short  time. 

Mr.  Towner.  So  far  as  I  am  concerned,  Mr.  Chairman  and  gentlemen  of  the  com- 
mittee, if  you  will  give  us  two  hours  to-day  we  will  close  our  testimony,  with  the 
understanding  that  a  like  limitation  is  placed  on  the  other  side  with  regard  to  the 
hours  taken. 

The  Chairman.  Well,  Judge  Towner  and  members  of  the  committee,  as  chairman 
I  shall  have  to  object  to  any  such  arrangement.  I  am  here  as  an  umpire  under  the 
circumstances  to  see  that  fair  play  is  meted  out  to  everybody.  It  is  a  matter  of  history 
and  fact  that  the  proponents  of  this  bill  had  an  unlimited  time  in  the  last  session  of 
Congress,  talked  as  long  and  as  much  as  they  wanted  to;  no  interruptions  and  no  limi- 
tations. They  had  prepared  an  immense  amount  of  evidence  and  brought  it  together 
in  the  form  of  a  printed  document,  which  the  Government  has  published.  Now,  to 
come  here  and  take  hold  of  your  opponents,  who  were  not  organized  at  the  time,  who 
did  not  know  this  hearing  was  going  on,  and  shut  them  off  at  two  hours,  against  a  long 
series  of  days  in  the  last  Congress,  plus  the  time  they  have  had  here,  is  manifestly 
unfair,  and  as  chairman  I  can  not  subscribe  to  any  such  plan.  I  am  perfectly  -mdling 
and  glad  to  help  the  opponents  and^he  proponents  to  get  together  and  come  to  a  reason- 
able agreement  as  to  limitation,  but  I  think  the  objection  on  the  part  of  the  opponents, 
who  have  not  had  a  chance  in  coiu-t,  should  not  be  kept  down  to  any  few  number  of 
hours  which  it  may  take  the  propbnents  to  finish  their  case.  I  do  not  think  that  is 
an  equitable  arrangement. 

Mr.  Huddleston.  May  I  not  ask.  Judge  Towner,  whether  the  proponents  of  this 
bill  would  not  be  willing  to  fix  a  certain  limit  of  time  for  their  presentation  of  the 
case,  without  regard  to  the  opposition,  your  initial  presentation,  with  the  opportunity 
to  reply?  Assuredly  no  useful  prupose  is  attained  by  indefinite  talk.  I  have  no 
doubt  myself  that  every  possible  thing  that  could  be  said  on  both  sides  of  this  ques- 
tion can  be  said  in  two  hours  on  each  side,  and  repetition,  killing  time,  serves  no 
useful  purpose.  Of  course,  witnesses  may  want  to  speak,  may  want  to  express  them- 
selves, but  if  they  have  nothing  new  to  say,  what  is  the  use  of  taking  up  the  time? 
That  is  the  point  of  view  I  have.  We  are  here  to  get  information,  not  to  afford  people 
an  opportunity  to  get  into  the  record. 

Mr.  Towner.  I  entirely  agree  with  the  gentleman,  and  I  have  offered  to  submit 
the  matter  without  any  testimony  whatever,  relying  upon  the  testimony  that  has 
been  adduced  already  in  the  previous  hearings.  I  have  offered  to  limit  it  to  a  number 
of  witnesses.  I  have  offered  to  limit  it  to  a  number  of  hours.  I  Kill  accept  any 
limitation,,  any  arrangement  that  is  reasonable. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  41 

Mr.  HuDDLESTON.  Can't  you  say  what  you  want  to  say  within  a  certain  limit  which 
you  fix,  and  then  you  present  the  witnesses  that  you  want  to  have  talk? 

Mr.  Towner.  I  would  be  ^nlling  to  do  that. 

Mr.  IIuDDLESTON.  Then  the  other  people  do  whatever  they  Hke  to  do. 

Mr.  TowNEU.  That  is  very  true,  but  under  those  circumstances  wouldn't  it  be  fair 
that  at  least  we  should  have  a  very  limited  amount  of  time  in  rebuttal  testimony? 

The  Chairman.  That  has  been  agreed  to  already.  That  was  agreed  to  on  the  first 
dav  of  the  hearing. 

Mr.  Towner.  Then  we  are  perfectly  willing  that  if  we  can  have  two  hours  to-day 
we  will  close,  if  we  liave  a  short  time  for  rebuttal  after  the  clo.se. 

Mr.  Rayburn.  You  can't  have  but  half  an  hour  to-day,  because  it  is  10.30  now. 

Mr.  Towner.  We  will  close  just  as  soon  as  it  is  possible. 

Mr.  Graham.  May  I  address  an  inquiiy  to  Mr.  Rayburn?  I  don't  know  what  time 
during  the  day — you  probably  don't  either — that  you  will  take  your  time  on  the  floor, 
but  I  was  wondering  if  we  could  take  time  tills  afternoon  for  a  session  of  the  committee 
at  some  time  that  would  not  inconvenience  you,  and  let  the  proponents  of  this  bill 
finish. 

Mr.  Rayburn.  It  always  inconveniences  me  to  be  in  committee  when  the  House 
is  in  session,  because  I  am  always  on  the  floor  when  the  House  meets. 

Mr.  Graham.  I  know  you  are.  • 

Mr.  Rayburn.  And  I  should  object  to  a  session  of  the  committee  in  the  afternoon. 

Mr.  Towner.  Would  it  suit  you,  Mr.  Rayburn,  to  have  a  session  to-night?  We  will 
close  to-night  if  you  like. 

Mr.  Rayburn.  Wellj  that  is  a  question  for  the  committee  to  determine.  I  could 
not  prevent  that  if  I  wanted  to.  I  can  prevent  the  committee  from  sitting  during 
sessions  of  the  House  by  objection,  but  I  always  meet  with  the  committee  when  the 
House  is  not  in  session,  when  it  meets. 

Mr.  Towner.  We  are  willing  to  do  anything  and  everything  that  can  be  suggested 
that  %vill  be  fair. 

_  The  Chairman.  Judge  Towner,  when  you  speak  of  two  hours,  do  you  want  the 
time  occupied  by  the  delivery  and  answer  of  questions  to  the  committee  and  from  the 
committee  deducted  from  your  two  hours  or  included? 

Mr.  Towner.  Well,  I  don't  know.  We  will  try  and  get  along,  Mr.  Chairman,  upon 
that  proposition.  I  think  we  will  be  able  to  get  through  with  everybody  under  those 
circumstances. 

_  The  Chairman.  The  committee  might  not  be  able  to  get  through,  and  if  you  don't 
give  the  members  of  the  committee  a  chance  to  ask  the  questions  that  they  have  in 
their  minds,  there  is  going  to  be  sonie  trouble  sooner  or  latex. 

Mr.  Towner.  I  would  say,  Mr.  Chairman,  of  course  I  had  in  mind  the  time  that  we 
would  necessarily  occupy.  We  have  four  witnesses  that  we  want  to  introduce  this 
morning,  and  while  most  of  them  will  not  be  very  long,  one  of  the  witnesses  we  regard 
as  a  very  important  witness,  and  it  might  be  that  the  chairman  would  desire  to  ask 
some  questions,  and  the  members  of  the  committee  might  desire  to  ask  some  ques- 
tions. 

Mr.  Cooper.  Mr.  Chairman,  I  want  to  ask  this  question,  if  it  is  possible  to  find  out  of 
the  opponents  of  this  bill  how  much  time  they  would  like  to  have.  Judge  Towner 
has  expressed  himself.  Now,  if  the  opponents  of  the  bill  are  here,  or  anyone  is  here 
to  speak  for  them,  I  would  like  to  find  that  out. 

The  Chairman.  Perhaps  the  chairman  is  in  the  best  position  to  answer  that.  The 
opponents  apparently  have  no  combination  of  personnel  or  participation  which  would 
make  it  easily  possible  for  them  without  notice  to  decide  that  question  in  answer  to 
your  proposition.  We  could,  however,  ask  all  those  present  who  are  opposed  to. the 
bill  to  meet  and  if  possible  to  organize  for  the  piu-pose  of  considering  the  matter  of 
time.  So  far  as  the  Chair  knows,  there  is  a  little  bunch  here  and  a  little  bunch  there, 
and  they  have  not  been  whipped  up  together  under  any  arrangement  of  law  and  order, 
or  for  the  purposes  of  propaganda,  so  that  they  are  not  in  hand  to  decide  until  they  may 
have  met  together.  Now,  it  is  only  fair  that  we  ask  them  to  get  together,  and  the 
Chair  is  under  a  certain  obligation  in  respect  of  many  people  who  have  written  in 
asking  to  be  notified  ahead  of  time  in  order  that  they  may  come. 

If  the  committee  desires  to  have  the  chairman  try  to  get  the  forces  of  the  opponents, 
so  far  as  he  knows  them,  to  get  together  \vith  a  \iew  to  limiting  the  time,  it  will  be  a 
great  pleasure  for  the  chairman  to  do  that. 

Mr.  Cooper.  I  for  one  w^ould  appreciate  it.  Then  we  would  know  just  what  we  are 
going  to  do. 

Mr.  Towner.  Mr.  Chairman,  shall  I  introduce  the  first  witness? 

The  Chairman.  If  you  please. 

Mr.  Towner.  I  will  ask  the  committee  to  hear  Cr.  Ellen  C.  Potter,  who  is  the  di- 
rector of  the  division  of  child  health  of  the  Pennsylvania  State  Department  of  Health. 


42  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

STATEMENT  OF  DR.  ELLEN  C.  POTTER,  DIRECTOR  OF  THE  DIVISION 
OF  CHILD  HYGIENE,  PENNSYLVANIA  STATE  DEPARTMENT  OF 
HEALTH. 

Dr.  Potter.  l^Ir.  Chairman  and  members  of  the  committee,  I  feel  very  much  like 
a  horse  that  has  been  brought  up  to  the  hurdle  twice  and  then  bolted  by  the  side  of 
it,  and  now  I  realize  I  have  got  to  go  over  on  behalf  of  this  bill. 

I  presume  that  in  your  past  you  have  at  some  time  read  Artemus  V\^ard.  You 
remember  he  says  "the  trouble  with  so  many  people  is,  they  know  such  a  lot  that 
ain't  so. "  We  who  have  been  following  the  opposition  to  this  bill  for  the  last  two 
and  a  half  jears  have  begun  to  realize  that  that  is  one  of  the  difficulties  in  regard  to 
it,  that  the  people  who  are  against  it  know  such  a  lot  that  "ain't  so"  about  it. 

Now  I  am  not  going  to  take  your  time  and  mine  to  knock  down  the  straw  men  that 
are  set  up  in  opposition  to  this  bill,  but  I  do  want  to  tell  you,  if  I  can  in  the  time  that 
is  allotted  to  me,  what  this  bill  will  mean  to  at  least  one  great  State  of  the  Union, 
and  how  it  will  work  in  connection  with  that  State. 

Yesterday  the  question  was  asked:  "What  is  the  Children's  Bureau  now  doing 
for  the  States?"  i  think  possibly  the  State  of  Pennsylvania  is  in  better  position  to 
answer  that  question  than  almost  any  other,  because  it  is  within  the  last  two  years 
that  our  division  of  child  health  has  been  organized  as  a  part  of  the  aftermath  of  the 
children's  year  which  was  mentioned  yesterday  as  having  been  put  on  by  the  Chil- 
dren's Bureau  about  1918.  Our  child  health  division  bureau  has  been  in  existence 
in  Pennsylvania  fur  approximately  2  years,  but  under  my  own  direction  for  14  months. 
When  I  was  brought  into  this  division  my  first  act  was  to  come  to  Washngton  to  the 
Children's  Bureau  to  get  all  the  information  that  I  could  as  to  the  method  of  organiza- 
tion, budget,  literature,  and  all  that  sort  of  thing;  and  I  am  quite  frank  to  say  that  I 
received  the  most  valuable  information  that  any  State  director' could  possibly  get, 
and  during  the  whole  year  and  more  that  has  intervened  I  have  been  in  constant 
communication  with  the  representatives  of  the  bureau,  asking  them  for  advice  of 
all  sorts  on  all  sorts  of  questions,  and  I  have  never  been  left  without  some  satisfactory 
answer  which  I  could  put  to  good  use  in  the  development  of  the  work  in  my  own 
State.  That  being  the  case,  it  seems  to  me  that  it  is  not  without  significance  that  I 
should  be  sent  by  the  official  State  organization  down  here  to  speak  on  behalf  of  this 
bill. 

We  have  had  experience  for  a  year  and  more  with  the  Children's  Bureau  and  still 
want  more  of  it,  which  would  be  provided  through  the  passage  of  this  bill.  It  seems 
to  me  that  other  States  as  well  as  Pennsylvania  would  profit  by  anything  that  would 
make  it  possible  for  the  Children's  Bureau  to  gjve  more  ad^'ice  and  more  help  to  a 
State.  I  am  here  not  only  on  behalf  of  official  Pennsylvania,  but  I  am  also  here 
as  representing  the  thi-ee  great  women's  organizations  of  the  State,  the  League  of 
Women  Voters,  the  Federated  Clubs,  and  the  W.  C.  T.  U.,  of  which  I  am  a  member, 
and  these  three  organizations  have  cooperated  with  us  in  a  very  splendid  way  in 
making  known  to  our  own  men  in  Congress  the  fact  that  the  folks  back- home  did 
want  the  Sheppard-Towner  bill  passed.  Not  onlj^  so  but  these  women  have  helped 
materially  in  insuring  the  success  of  the  child  health  diAT-sion  in  our  State. 

You  know  jtist  as  well  as  I  that  we  are  next  to  the  richest  State  in  the  Union,  and 
possibly  as  you  think  of  that  you  will  say,  "Well,  if  you  are  so  rich,  why  in  the  world 
don't  you  go  ahead  and  do  this  work,  if  you  think  it  is  so  well  worth  while  doing?" 
There  are  two  or  three  reasons  which  hold  not  only  in  our  State  but  in  other  States  as 
well,  as  to  why  we  don't  go  ahead  on  our  own.  The  first  one  is  a  fact  which  I  feel  is 
known  to  you,  and  that  is  that  most  legislators  are  timid  about  embarking  on  what 
seems  to  them  a  new  undertaking  in  Government.  They  are  timid  about  it,  not 
appreciating  that  they  have  possibly  the  right  to  go  ahead  and  create  precedents. 
They  are  waiting  to  be  shown  by  somebody  liigher  up  that  this  certain  thing  is  a 
legitimate  function  of  government.  They  are  not  in  the  position  that  you  are,  to  be 
familiar  with  what  is  going  on  in  the  nations  across  the  sea,  knowing  that  over  there 
they  have  worked  out  as  part  of  the  governmental  function  the  protection  of  infancy 
and  maternity,  a  perfectly  legitimate  function  of  government;  they  are  not  familiar 
with  those  things  as  you  are,  and  you  are  in  your  positions  because  the  people  back 
home  have  recognized  in  you  capacities  for  leadership,  and  they  have  sent  you  here 
to  provide  that  leadership,  and  legislatures  back  home  are  looking  to  you  to  indicate 
the  way  to  proceed. 

In  spite  of  the  fact  that  Pennsylvania  has  not  done  anything  in  a  very  large  way, 
Pennsylvania  has  done  some  things  on  its  own  initiative  during  this  past  year  and  has 
done  it  because,  first,  we  have  a  governor  who  has  really  a  vision  for  the  welfare  of  its 
people;  and  then  because  he  is  advised  by  a  commissioner  of  health  who  has  imagina- 
tion and  who  sees  that  the  whole  future  of  public  health  is  based  on  the  protection  of 


PUBLIC  PROTECTION   OF   MATEBNITY  AND   INFANCY.  43 

maternity  and  infancy,  and  that  unless  nations  and  States  protect  life  at  its  source, 
they  can  not  continue  to  be  ^reat  nations. 

And  so,  under  the  leadership  of  our  j^ovemor  and  of  our  Commissioner  of  Health,  we 
have  modest  appropriations  with  which  we  are  going  ahead  on  our  child  health  work. 
Also  at  tliis  la.-^!  session  of  the  legislature  our  men  went  so  far  as  to  pass  an  enabling 
act  which  said  that  if  the  Federal  (lovernment  does  appropriate  funds  for  the  pro- 
tection of  maternity  and  infancy — they  went  so  far  as  to  say  old  age — that  the  State 
of  Pennsylvania  would  authorize  its  health  department  to  accept  such  funds  and  to 
meet  the  conditions  of  the  bill  to  carry  out  its  purposes.  They  are  waiting  to  be  shown, 
and  it  takes  a  sum  of  monev  to  show  people  that  sort  of  thing. 

The  second  reason  why  ^Pennsylvania  and  other  States  have  not  gone  ahead  in  a 
large  way  on  child-health  work  is  due  to  one  great  American  characteristic,  which 
is  that  we  do  things  much  better,  with  much  more  entliusiasm  and  nerve  when  we 
do  it  as  a  mass  movement,  whether  it  is  bii>-ing  Liberty  bonds,  whether  it  is  making 
surgical  dressings,  whether  it  is  saving  lives  of  mothers  and  babies.  We  do  things 
as  a  mass  better  and  in  a  very  splendid  way  when  we  do  not  like  to  do  it,  when  we 
are  afraid  to  do  it  as  individual  units. 

You  are  the  people  who  can  create  that  mass  movement  for  child  welfare,  which 
is  certain  to  be  the  great  fundamental  work  in  public  health  in  the  years  to  come. 
When  you,  as  you  can  in  this  bill,  say  to  the  legislatures  back  home,  "We  do  believe 
that  it  is  a  proper  function  of  government  to  save  the  lives  of  mothers  and  babies; 
we  do  believe  that  it  is  one  of  t^he  most  worth-while  things  in  the  world ;  we  believe 
in  it  so  strongly  that  we  are  willing  to  go  50-50  for  the  next  year  with  you  on  yoiir 
expenses  to  put  this  work  across.''  When  you  say  that,  you  will  have  placed  the 
departments  of  health  of  the  various  States  in  a  position  to  "show"  their  own  legis- 
latures and  to  show  their  own  people  what  can  be  done  in  this  work  for  mothers  and 
children.  When  they  have  been  shown  there  will  not  he  the  slightest  doubt  in  the 
world  that  adequate  appropriations  will  be  made  by  the  States  in  the  future  to  take 
care  of  their  own  work,  because  in  this  bill  you  say  that  "it  is  to  be  done  by  you, 
for  your  own  babies,  and  for  the  mothers  of  those  babies,  and  not  by  any  higher  power 
from  outside  the  State." 

I  have  said  "adequate  appropriations."  I  understand  that  that  is  one  of  the 
greatest  bugaboos  in  connection  with  this  bill,  that  it  is  going  to  build  up  such  tre- 
mendous appropriations  that  will  ultimately  have  to  be  taken  out  of  the  taxes.  You 
have  not  as  yet  had  experience  with  the  thrifty  administration  of  funds  by  women 
in  official  work.  I  can  say  most  emphatically  that  as  far  as  the  work  is  concerned 
in  Pennsylvania  and  the  way  that  these  funds  will  be  applied  and  the  way  that  this 
work  will  be  carried  on,  just  as  we  are  doing  it  now  in  a  small  way,  it  will  not  build 
up  huge  obligations  and  taxes.  Let  me  give  you  just  one  illustration  that  will  prove 
that. 

Last  June,  in  Lycoming  County,  the  tuberculosis  association  wanted  to  make  a 
special  study.  They  wanted  help  from  the  health  department.  The  only  depart- 
ment that  could  give  aid  at  that  time  was  the  di\ision  of  child  health.  There  was 
no  public  health  work  done  in  that  county  except  the  tuberculosis  work,  which  was 
done  by  our  State,  and  which  is  pro\-ided  for  liberally  in  our  State  appropriations. 
I  said  to  my  agent  who  went  up  there — and  by  the  way,  she  was  a  "nontechnical" 
person — "The  thing  that  I  want  out  of  your  help  in  that  region  are  baby  health  sta- 
tions started  in  that  county."  There  were  no  public  health  nurses  up  there,  save  one 
State  nurse  in  tuberculosis.  There  were  no  baby  health  stations,  no  visiting  nurse 
ser\-ice. 

On  the  15th  of  last  July  the  first  baby  health  station  opened;  to-day  there  are  two 
baby  health  stations  in  Williamsport,  with  a  registration  of  over  500  babies  in  them. 
There  is  a  \isiting  nurse  ser\ice  established  in  Williamsport  -with  at  least  two  nurses 
besides  the  super^•isor.  Outside  of  Williamsport,  in  Little  Jersey  Shore,  there  is 
another  baby  health  station  with  its  own  nurse  and  visiting  nurse  service,  and  on 
the  other  side  of  Williamsport,  at  Montgomery,  is  still  another  station  with  its  own 
nurse  and  visiting  nurse  ser^ice.  There  are  four  public  health  nurse  ser\-ices  in  that 
county,  500  babies  registered  in  just  one  of  the  four  clinics,  and  prenatal  work  going 
on  in  all  those  stations  in  a  small  way,  but,  nevertheless,  going  on.  And  you  say, 
"How  much  does  it  cost?" 

ilr.  }iIerritt.  EIow  were  these  baby  stations  started?    Was  it  a  private  enterprise? 

Dr.  Potter.  Xo:  my  "nontechnical  -  agent  went  up  there  -nith  the  idea  of  organ- 
izing the  community  to  do  its  own  work.  She  brought  together  the  people  who 
were  interested  in  the  Red  Cross,  the  Antituberculosis  Society  in  our  own  State  work, 
the  League  of  AVomen  Voters,  and  various  other  people.  They  got  together  and  de- 
cided that  they  would  establish  community  health  work.  The  funds  came  from  the 
Antituberculosis  Society,  from  the  Red  Cross,  and  by  voluntary  contribution,  and 


44  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

all  tills  work  is  done  without  resort  to  the  treasury  either  of  the  city  of  Williamsj.  ort 
or  the  county  of  Lycoming,  and  the  only  expense  that  it  has  been  to  the  State  was 
the  traveling  and  maintenance  expenses  of  that  agent,  who  was  up  there  for  possibly 
six  weeks,  and  the  munificent  sum  of  $1.50  an  hour  which  was  paid  to  the  doctor 
who  had  charge  of  the  clinic  for  two  hours  each  week — a  perfectly  splendid  man. 
And  that  possibly  might  lead  me  to  say  that  we  have  only  40  doctors  on  our  pay  roll, 
and  we  pay  them  at  the  rate  of  $1.50  an  hour  for  their  service.  They  usually  serve 
about  two  hom-s  a  week,  but  we  have  scores  and  scores  of  physicians  who  are  serving 
in  our  stations  without  compensation  of  any  sort,  and  one  whom  I  take  great  pleasiire 
in  mentioning  is  the  head  of  the  pediatric  section  of  the  State  Medical  Society  of 
Pennsylvania,  Dr.  Henry  J.  Curtin.  So,  you  see,  we  have  the  backing  of  the  medical 
profession  in  the  work  that  we  are  doing,  because  we  have  demonstrated  to  them 
that  this  sortof  work  does  not  spoil  the  doctors'  practice.  It  doesn't  at  all.  In  the 
city  of  Homestead,  where  last  summer  we  made  a  special  study  of  diarrheal  diseases 
of  children  and  where  absolutely  no  treatment  was  given  to  the  babies,  liut  advise 
was  given  to  the  mothers  as  to  their  care,  the  doctors  told  us  at  the  end  of  the  sum- 
mer that  they  had  never  had  such  a  prosperous  summer,  as  far  as  finances  were  con- 
cerned, and  that  they  had  never  had  such  a  satisfactory  summer,  in  that  they  secured 
the  sick  babies  before  they  were  so  desperately  sick  that  they  could  not  do  anything 
for  them.  That  is  the  way  that  it  works  out  in  one  town,  with  no  expense  save  that 
expense  which  was  first  incurred  to  bring  the  community  together  to  a  realization 
of  what  it  could  do  for  itself,  and  thatis  what  we  believe  this  bill  will  make  possible 
all  over  the  United  States. 

Mr.  Graham.  Let  me  interrupt  you  right  there.  That  illustrates  something  that  I 
want  to  speak  of.  I  have  had  a  little  bit  of  experience  with  Federal  bureaus  and 
Federal  commissions  and  boards,  and  so  on.  I  have  observed  that  they  are  the  least 
efficient  and  the  most  extravagant  of  almost  any  institution  in  the  country,  while 
such  enterprises  conducted  by  commissions  of  State  and  in  local  communities,  in  places  - 
like  the  city  of  New  York,  which  Dr.  Baker  told  us  about,  have  been  usually  admin- 
istered efficiently  and  with  a  minimum  cost.  Now,  the  thought  very  strongly  in  my 
mind  is,  when  the  Federal  Government  gets  into  this  thing,  whether  the  appropria- 
tions will  not  mount  by  jumps  and  bounds  and  whether  there  will  not  be  built  up 
in  the  Government  here,  as  I  have  seen  done  time  after  time,  a  great  monumental 
organization  that  will  expend  large  sums  of  money,  and  perhaps  not  efficiently.  I 
would  like  somebody's  idea  about  that. 

Fm-hermore,  I  want  some  one,  before  Judge  Towner  concludes  with  Ms  list  of  wit- 
nesses, to  tell  me  something  about  the  legal  phases  of  this  proposition,  as  to  the  rights 
of  Congress  under  the  Constitution  to  make  appropriations  for  tliis  particular  piupose, 
and  as  to  the  advisability  of  the  Government  making  appropriations  to  be  spent  by 
the  States  for  what  has  been  heretofore  considered  exclusively  State  business. 

I  have  no  doubt  as  to  the  desirability  of  this  work,  and,  accepting  the  figm'es  that 
have  been  given  here  as  true,  it  appears  very  manifest  that  it  ought  to  be  done;  but 
shall  the  Federal  Government  go  into  it  in  a  financial  way,  other  than  establishing  a 
bineau  here  which  shall  help  the  States  to  build  up  this  work  in  their  own  way? 

Dr.  Potter.  As  I  understand  the  purposes  of  this  bill,  it  is  largely  to  teach  and 
help  the  States  to  help  themselves,  the  States  in  turn  to  teach  their  counties  to  help 
themselves. 

Mr.  Graham.  But  added  to  that  is  the  feature  which  I  have  grave  doubt  about, 
namely,  appropriating  sums  of  money  out  of  the  Federal  Treasury,  raised  by  general 
Federal  taxation,  giving  it  to  the  States  to  be  used  by  the  States  in  this  work.  Now, 
I  want  some  Light  on  that. 

Dr.  Potter.  That  would  bring  the  highway  construction  and  venereal-disease  con- 
trol in  question  also. 

Mr.  Graham.  I  understand.  That  argument  has  been  made  to  me  time  and  time 
again,  that  it  is  an  analogous  case,  but  irrespective  of  what  the  Congress  has  done  in 
the  past,  what  about  this  particular  instance?  I  do  not  believe  that  it  is  a  fair  argu- 
ment for  one  to  compare  what  we  might  do  now  with  something  that  has  been  done 
heretofore,  because  what  has  been  done  heretofore  may  not  have  been  well  considered. 

Dr.  Potter.  That  is  very  true.  It  seems  to  me,  however,  that  it  is  just  as  strictly 
a  function  of  Government  to  conserve  life  at  its  source  as  it  is  to  conserve  and  to  re- 
habilitate men  who  have  been  wounded  and  injured  in  battle.  They  are  citizens 
of  the  United  States;  they  have  rendered  great  service  to  the  Union,  but  there  would 
be  no  Union,  there  would  be  no  great  United  States,  without  the  people  in  it,  and  the 
women  and  children  are  as  much  an  obligation  of  the  State,  of  the  Government,  Na- 
tional or  State,  as  are  these  others. 

Mr.  Graham.  There  is  no  greater  asset  of  any  State  than  its  mothers  and  children. 
I  agree  with  you  on  that,  and  there  is  nothing  we  are  more  interested  in  than  the 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  45 

conservation  of  these  essential  things,  but  we  have  a  Government  that  is  constitutional 
in  its  form,  and  we  are  limited  to  certain  particular  powers  and  functions — that  is,  the 
Congress  of  the  United  States,  the  legislative  body,  is.  Now,  what  about  the  powers  of 
this  committee  and  the  Congress  to  go  into  that  sort  of  tiling? 

Dr.  Potter.  Someone  other  than  myself,  versed  in  constitutional  law,  would  have 
to  answer  that  question,  because  I  don't  know.  Ass'uming  that  it  has  been  legal  to 
appropriate  to  States  for  other  purposes — we  started  our  venereal  disease  control 
tlirough  grants  on  the  50-50  basis  from  the  Government — assuming  that  those  are 
legal,  it  seems  to  me  that  there  is  no  question  about  the  legality  of  the  appropriation 
for  the  work  for  mothers  and  children. 

Mr.  Graham.  I  suppose,  Mr.  Towner,  later  you  will  have  some  one  speak  on  that 
subject,  will  you? 

Mr.  Towner.  Yes;  I  will  be  glad  to  take  that  matter  up  with  the  gentleman.  It 
will  be  presented,  and  I  can  take  it  up  in  rebuttal. 

Dr.  Potter.  Now,  may  I  answer  just  one  other  question?  You  spoke  of  the  possible 
danger  of  building  up  a  great  organization  in  the  Federal  Government  to  carry  out  the 
purposes  of  this  liill.  I  feel  reasonably  certain  that  not  having  had  experience  in  the 
past,  as  you  have  not,  with  the  administration  done  by  womankind,  that  possibly  you 
will  find  that  the  work  is  not  built  up  in  that  way  under  the  gmdance  of  a  woman. 

Mr.  Graham.  I  will  welcome  that  day.     [Laughter.] 

Mr.  Cooper.  May  I  ask  you  this  question:  Is  it  not  a  fact  that  the  Federal  Govern- 
ment does  make  large  appropriations  of  money  in  which  the  States  get  the  benefit  for 
the  prevention  of  disease  in  cattle  and  hogs  and  agricultural  crops? 

Dr.  Potter.  Yes,  sir. 

Mr.  Cooper.  No  one  objects  to  that. 

Dr.  Potter.  No;  they  have  not  in  the  past,  at  least. 

Mr.  Rayburn.  That  is  food  for  human  beings. 

Dr.  Potter.  We  want  to  keep  the  human  beings  alive  to  eat  the  food. 

Mr.  Towxer.  Both  are  to  save  human  life. 

Mr.  Rayburn.  I  understand  that. 

Mr.  Graham.  There  is  a  difference  in  theory,  if  I  may  suggest.  There  is  this 
difference;  Such  appropriations  as  are  made  for  the  live-stock  industry,  we  will  say, 
are  made  on  the  theory  that  these  appropriations  are  to  be  used  by  the  Government 
to  stamp  out  certain  diseases  in  certain  localities,  which  ultimately  results  in  benefit 
to  the  whole  country;  but  here  is  a  proposition  to  appropriate  directly  to  the  States 
sums  of  money  to  be  used  by  the  States  in  this  work. 

Mr.  Towner.  Mr.  Chairman  and  Mr.  Graham,  may  we  not  let  Dr.  Potter  proceed 
now?    We  can  take  this  matter  up  later  and  thrash  it  out  among  ourselves. 

Dr.  Potter.  The  question  arises,  How  urgently  does  the  work  need  to  be  done? 
Poor  old  Pennsylvania,  in  spite  of  its  favorable  conditions,  is  about  seventeenth  down 
on  the  list  of  tlie  States  as  to  its  infant  mortality  rate.  Some  of  you  were  astonished 
at  the  rate  Dr.  Baker  mentioned,  144  deaths  per  thousand,  in  New  York  City.  In 
one  of  our  towns,  as  reported  in  a  publication  issued  by  Dr.  Van  Ingen  the  other  day, 
the  death  rate  was  225  per  thousand;  in  one  of  our  counties  the  death  rate  was  170 
per  thousand.     So  that  Pennsylvania  does  need  to  have  this  work  done. 

The  impression  seems  to  be  in  many  places  that  Pennsylvania  is  so  densely  popu- 
lated that  it  has  a  sufficient  number  of  hospitals  within  easy  reach  of  every  one ;  that 
it  has  doctors  within  easy  reach  and  nurses  also.  I  think  some  of  you  think  possibly 
we  have  to  take  up  our  cots  in  the  morning  and  store  them  away  in  order  to  get  room 
enough  to  step  around  and  do  our  work  in  the  daytime,  because  we  have  one-twelfth 
of  the  total  population  of  the  United  States  in  our  borders;  yet  in  our  State  there  are 
vast  stretches  of  tern  to  ly,  populated  territory,  without  a  doctor  or  hospital  or  nurse, 
or  even  a  midwife,  and  women  and  children  die  needlessly  because  they  can  not  get 
the  help  that  is  needed.  Let  me  give  you  just  one  illustration  out  of  the  northeastern 
corner  of  the  State,  from  which  I  came  just  a  few  days  ago. 

We  have  there,  not  in  the  employ  of  the  State,  but  a  woman  doctor  with  a  mis- 
sionary spirit.  She  goes  out  into  those  mountains,  which  are  popular  summer  resorts 
of  New  York,  New  Jersey,  and  Pennsylvania  and  helps  those  women  in  the  care  of 
their  children,  carrj/ing  the  kind  of  instruction  that  we  want  to  be  able  to  send  offi- 
cially and  to  help  the  counties  to  send  officially  into  those  regions.  One  day  she  had 
a  case  of  a  mother  with  her  little  baby  with  the  croup.  She  showed  that  mother  how 
to  make  a  cold  wet  compress,  which  did  relieve  the  condition  and  did  save  the  baby's 
life.  A  day  or  two  after  that  what  do  you  suppose  that  mother  did?  She  did  the 
same  thing  other  mothers  -will  do  all  over  this  land  if  they  are  only  given  the  right 
instructions.  She  tramped  9  miles  OA'er  the  mountains  with  her  baby  in  her  arms  to 
go  to  the  home  of  a  sister  who  had  a  baby  subject  to  croup,  just  as  her  own  was,  to  show 
her  how  to  put  on  cold  wet  packs,  so  that  some  time  in  emergency  that  baby  need  not 


46  PUBLIC   PROTECTIOlsr    OF    MATEKISriTY   AND   INFAIsTCY. 

die.  Then  she  tramped  over  the  trail  9  or  10  miles  back.  It  is,  as  Dr.  Baker  says, 
from  mouth  to  mouth  in  the  tenements  that  the  correct  instruction  is  given,  and  so 
it  will  be  on  the  mountains  and  plains.  But  some  one  must  be  there  to  start  the 
right  instruction  to  displace  the  old  wives'  tales. 

That  same  woman  doctor  by  telephone  from  the  forester's  cabin  was  called  in  the 
dead  of  winter  out  to  one  of  those  little  shacks  on  the  mountainside  where  a  new  life 
was  coming  into  the  world.  The  roads  were  unbroken  for  days;  the  postman  had  not 
gone  through,  but  with  her  sleigh  and  driver  and  pair  of  horses  she  went  out  to  the 
end  of  the  broken  roads.  Then  the  farmers  turning  out  ahead  of  her,  going  from 
7  o'clock  in  the  morning  till  7  o'clock  at  night  before  reaching  that  place  on  the  moun- 
tains, and  the  baby  coming  at  9,  the  little  shack  was  too  small  to  hold  the  group  that 
had  gone  up  there  to  help,  so  they  went  over  to  the  forester's  cabin  and  were  put  up 
for  the  night,  the  forester's  wife,  a  Virginia  girl,  giving  to  them  the  hospitality  that 
Virginia  knows  so  well  how  to  give.  Down  the  trail  in  the  morning,  the  baby  alive, 
the  mother  alive,  and  the  women  back  there  in  the  hills  knowing  that  there  was 
somebody  there  to  help.     It  is  that  sort  of  thing  that  we  want  to  do. 

Out  in  that  region  your  good  roads  are  going  through.  I  drove  over  some  of  them  the 
other  day,  and  it  is  on  those  good  roads  that  we  want  to  send  help  out  into  the  rural 
communities.  What  is  the  good  of  laying  clown  good  roads  if  you  are  not  going  to 
follow  it  up  with  «the  thing  that  is  most  essential — health  and  education — to  go  out 
into  those  regions?  And  it  is  in  those  regions  that  the  feeble-minded  and  the  degener- 
ate are  being  bred,  in  those  regions  that  have  been  deforested  and  from  which  the 
tanneries  have  gone,  and  those  people  are  either  too  poor  physically,  mentally,  or 
financially  to  get  out.  They  are  breeding  there  like  flies  and  dying  like  flies,  and  un- 
less we  can  send  the  pure  breath  of  health  and  help,  and  have  hospitals  within  reach, 
and  have  doctors  within  reach,  we  shall  not  have  done  our  duty  by  the  people  in  our 
State. 

Mr.  Hawes.  Doctor,  I  want  to  take  advantage  of  your  practical  experience  to  ask 
you  a  few  questions.  I  assume  that  there  is  not  a  man  on  this  committee  that  does  not 
want  to  help  the  work  which  you  and  your  organization  are  interested  in,  but  there 
are  certain  practical  questions  that  we  are  not  familiar  with.  You  are  a  member  of 
the  board  of  health  or  of  the  health  department? 

Dr.  Potter.  I  am  a  member  of  the  health  department,  not  of  the  board. 

Mr.  Hawes.  Do  you  know  the  amount  of  the  annual  appropriation  for  the  health 
department  in  the  State  of  Pennsylvania? 

Dr.  Potter.  Somewhere  between  $5,000,000  and  .?6, 000, 000  for  the  appropriation 
period  of  two  years,  which  for  the  year  would  be  $2,600,000  plus.  We  unfortunately 
had  to  l)e  cat  about  $350,000  this  year  because  so  large  a  share  of  the  State  funds  had 
to  be  given  to  education. 

Mr.  Hawes.  Between  $5,000,000  and  $6,000,000?  Now,  if  this  bill  went  through, 
you  would  have  added  to  that  first.  $10,000  which  each  State  gets;  then  your  propor- 
tion of  the  $1,000,000,  which  we  will  say  would  approximate  $30,000.  So  the  total 
contribution  of  the  United  States,  if  you  'apply  your  $6,000,000  spent  by  Pennsyl- 
vania, could  only  be  approximately  $40,000.     Is  that  correct?. 

Dr.  Potter.  I  don't  know  exactly  what  it  is,  but  if  our  State  population  is  about 
one-twelfth  of  the  total  population  of  the  United  States  that  would  be  our  proportion 
plus  the  $10,000. 

Mr.  Hawes.  That  would  be  all  that  you  would  secure  from  Uncle  Sam  under  this 
bill. 

Your  organization  acts  U;nder  the  direction  of  the  board  of  health  of  Pennsylvania? 

Dr.  Potter.  Under  the  commissioner  of  health,  who  has  associated  with  him  what 
is  called  an  advisory  board. 

Mr.  Hawes.  You  have  a  department  of  labor  in  Pennsylvania,  have  you  not? 

Mr.  Potter.  Ye",  sir. 

Mr.  Hawes.  Would  you  like  to  have  the  health  department  transferred  to  the 
department  of  labor  in  Pennsylvania? 

Dr.  Potter.  1  don't  think  it  would  be  possible. 

Mr.  Hawes.  Yet  this  bill  contemplates  that  48  States,  each  having  a  hea,lth  depart- 
ment, this  work  is  carried  on  by  that  particular  body;  it  is  to  be  placed  under  the 
national  direction  of  a  department  of  labor.     Is  that  correct? 

Dr.  Potter.  Not  under  the  direction  but  under  the  advice  and  help  and  assistance. 
And  we  have  learned  in  the  past  that  that  is  so  very  well  worth  having  that  we  are 
glad  to  have  it. 

Mr.  Hawes.  Would  it  not  be  rather  an  anomalous  situation  to  find  48  States  were 
attending  to  this  work  under  the  direction  of  health  department's,  and  now  the  Govern- 
ment comes  in  and  directs  it  to  be  done  under  the  Department  of  Labor? 


i 


PUBLIC  PROTECTION"   OF   MATERNITY  AND  INFANCY.  47 

Dr.  PoTTKR.  I  think  that  in  ansvvor  to  that  I  shoukl  prartically  ropoat  wliat  T)r 
Baker  said  yesterday,  that  in  our  State,  as  in  New  York  City,  we  believe  that  idti- 
mately  all  the  health  fi'.nctionfi  of  tne  (Jo/ernment  ousi;ht  to  he  under  a  department  of 
liealth,  and  that  we  l)elieve  that  very  probably  in  the  reori^nxnizalion  ])lans  whieh  are 
in  proiji-esa,  that  will  hap])(>n.  We  believe,  however,  that  this  woi'k  is  so  tremendously 
important  that  it  O(io;ht  to  l)e  done  at  once;  we  believe  that  the  bureau  in  whieh  it  is 
now  vested  is  tlu^  one  that  should  undertake  it,  and  the  future  we  believe  will  take 
care  of  itself  in  that  necessary  adjustment. 

Mr.  IIawes.  Doctor,  we  are  witing  a  law,  and  T  understand  that  the  Child  Bureau 
of  the  Department  of  T.abor  has  been  an  eminent  succes-'s,  directed  })y  women  of  ex- 
ceptional capacity,  and  they  have  acquired  by  experience  an  added  abilitv,  but  wliy 
can  not  that  de]iartment  be  placed  under  the  national  dej)artment  of  health,'  the  same 
as  every  other  State  function? 

Dr.  Potter.  You  can  make  your  laws  just  as  you  choose. 

Mr.  IIawes.  Would  tliere  be  any  objection  if  we  changed  voiir  bill  to  pro\-ide  for 
mo\Tin.a;  the  Children's  Bureau  from  the  Department  of  Labor  to  the  department  of 
health?    Would  there  be  objection  to  that? 

Dr.  Potter.  If  there  is  a  national  department  of  health  created,  I  should  certainly 
think  tliat  the  (  hildren's  Bureau  would  function  best  there. 

The  Chairman.  The  chairman  regrets  that  he  has  to  call  attention  to  the  fact  that 
the  hour  of  11  o'clock  has  arrived,  and  by  vote  of  the  committee  that  means  the  termi- 
nation of  this  hearing,  unless  the  committee  sees  fit  to  extend  the  time. 

Mr.  Hawes.  Mr.  Chairman,  I  think  we  ought  to  give  these  witnesses  a  night  session. 

Mr.  Merritt.  I  move  that  the  committee  proceed  until  12  o'clock. 

Mr.  Hawes.  I  move,  Mr.  Chairman,  that  we  hold  a  night  session. 

Mr.  Rayburn.  I  make  the  point  of  order,  Mr.  (Iiairman,  that  the  House  will  be  in 
session  to-night  if  the  program  is  carried  out,  and  this  committee  can  not  sit  during  the 
sessions  of  the  Horse,  except  by  unanimous  consent  or  consent  of  the  House. 

The  Chairman.  Well,  we  niight  get  around  it  by  saying  that  we  would  call  the 
meeting  to-night  subject  to  the  session  of  the  House. 

Mr.  Bayburn.  To  overcome  the  objection,  if  the  House  is  not  in  session,  we  might 
meet  at  9  o'clock  in  the  morning  or  8  o'clock  in  the  morning — any  time. 

i\fr.  Hawes.  In  order  to  conform  to  Mr.  Rayburn's  objection,  I  will  so  amend  my 
motion. 

The  Chairman.  Then  that  puts  on  the  witnesses  and  on  the  committee  the  necessity 
of  finding  oi  t  whether  the  House  meets,  and  coming  and  taking  their  chances. 

Mr.  Hawfs.  Then  I  withdraw  my  motion  entirely,  due  to  objection. 

Mr.  Parker.  Vr.  Chairman,  I  move  that  we  meet  to-morrow  morning  at  9  o'clock. 

The  Chairman.  Are  there  any  remarks  on  that  motion? 

(The  motion  was  seconded,  put,  and  carried.     Whereupon,  at  11  o'clock  a.  m. 
the  committee  adjo'  rned  until  9  o'clock  a.  m.,  Friday,  July  15,  1921.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Friday,  July  15,  1921. 
The  committee  met  at  9  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

The  Chairman.  The  committee  will  come  to  order.  Judge  Towner,  will  vou 
resume,  please. 

Mr.  Towner.  Mr.  Chairman,.  I  will  ask  Dr.  John  A.  Ryan,  who  is  professor  of 
economics  of  the  Catholic  University  of  America,  and  also  is  director  of  the  National 
Catholic  Welfare  Council,  to  take  the  stand. 

STATEMENT  OF  REV.  DR.  JOHN  A.  RYAN,  CATHOLIC  UNIVERSITY 
OF  AMERICA,  WASHINGTON,  D.  C. 

The  (Ihairman.  Will  you  give  your  full  name  and  residence? 

Rev.  Dr.  Ryan.  John  A.  Ryan.     Catholic  University,  Washington. 

I  should  like  to  preface  the  few  direct  remarks  on  the  bill  which  I  have  to  offer, 
with  a  word  of  explanation,  especially  since  Judge  Towner  has  just  committed  one  of 
the  mistakes  which  is  involved  in  this  explanation.  Judge  Towner  referred  to  me  as 
director  of  the  National  Catholic  Welfare  Council.  I  am^not  that.  I  am  director  of 
one  department  of  the  council.  Some  time  ago  the  National  Catholic  Welfare  Council 
issued  a  statement  in  favor  of  this  bill.  A  few  weeks  or  months  later  a  gentleman  in 
this  city,  who  I  believe  is  actively  identified  with  the  opposition  to  this  bill,  asked  me 


48  PUBLIC  PROTECTIOISr   OP   MATERNITY  AND  INPANCY. 

in  the  course  of  some  correspondence  on  the  subject,  whether  I  thought  the  National 
Catholic  Welfare  Council  intended  actively  to  support  the  bill.  I  answered  that  my 
impression  was  that  the  National  Catholic  Welfare  Council  would  not  do  any  more 
than  it  had  already  done  in  its  formal  statement;  that  it  would  not  engage  actively  in 
supporting  or  advocating  the  bill. 

That  statement  was  taken  out  of  my  letter  and  printed,  made  the  basis  of  a  con- 
siderable editorial,  in  which  it  was  argued  that  this  statement  of  mine  was  proof  that 
the  National  Catholic  Welfare  Council  had  seen  the  error  of  its  ways  in  indorsing  the 
bill,  and  was  now  going  to  withdraw,  or  practically  had  withdrawn  its  indorsement, 
because,  the  editorial  said,  the  director  of  the  National  Catholic  Welfare  Council  now 
writes  thus.  Well,  the  letterhead  upon  which  I  wrote  would  have  shown  the  gentle- 
man that  the  directive  authority  of  the  National  Catholic  Welfare  Council  is  in  the 
hands  of  seven  bishops.  That  I  am  merely  director,  and  only  one  of  the  two  directors 
of  one  of  its  departments,  so  that  I  have  not  the  authority  that  was  attributed  to  me, 
nor  did  my  statement  mean  that  the  National  Catholic  Welfare  Council  had  in  any 
way  rescinded  or  modified  its  original  statement. 

Now  there  are  only  two  or  three  points,  Mr.  Chairman,  that  I  care  to  take  up. 

Mr.  Sweet.  Just  in  that  connection,  I  understand  though;  from  your  statement 
here,  that  you  are  for  this  bill? 

Rev.  Dr.  Ryan.  Yes,  sir. 

Mr.  Sweet.  And  that  while  not  taking  an  active  part  in  advocating  it,  yet  you 
believe  that  it  will  be  a  good  thing  for  the  country? 

Rev.  Dr.  Ryan.  Yes,  sir.  I  might  say  that  the  fact  that  the  National  Catholic 
Welfare  Council  is  not  taking  any  active  part  in  promoting  the  bill  is  not  an  exceptional 
fact  at  all.  The  National  Catholic  Welfare  Council  has  indorsed  a  great  many  other 
bills,  most  of  which  it  has  not  taken  any  position  on  in  an  active  way  as  the  bills  pro- 
gressed in  the  Congress. 

I\'Ir.  Sweet.  I  understand  the  National  Catholic  Welfare  Council  is  taking  its  usual 
conservative  stand  with  regard  to  public  measiires. 

Rev.  Dr.  Ryan.  Exactly. 

Mr.  Towner.  Let  me  interrupt,  Father.     But  it  has  unreservedly  indorsed  this  bill? 

Rev.  Dr.  Ryan.  Yes. 

The  Chairman.  Will  you  please  repeat  that? 

Rev.  Dr.  Ryan.  It  has  unreservedly  indorsed  this  bill,  Judge  Towner  said. 

The  Chairman.  The  council? 

Rev.  Dr.  PtYAN.  The  council;  yes. 

The  Chairman.  Well,  now,  on  that  will  you  have  the  committee  understand  from 
that  that  it  has  unreservedly  indorsed  this  bill  against  all  other  possible  considerations, 
or  just  the  purpose  of  the  bill? 

Rev.  Dr.  Rran.  Oh,  the  indorsement  does  not  mean  that  all  the  details  and  pro- 
visions of  this  particular  bill  are  approved,  but  just  the  general  purpose. 

The  Chairman.  The  general  purposes  of  the  bill? 

Rev.  Dr.  Ryan.  Yes.  And  the  bill  as  it  then  was  formed.  Let  me  add  one  more 
word  of  ex]planation.  The  National  Catholic  Welfare  Council  ha?  not  the  authority 
of  a  disviplinary  or  governing  body  in  the  church.  Any  Catholic  is  perfectly  free  to 
dissent  and  to  dissent  publicly  from  its  opinions  if  he  likes.  As  a  matter  of  fact  some 
Catholics,  at  least,  have  dissented  from  the  action  of  the  council  on  this  bill  and  have 
criticised  it.  But  I  am  simply  trying  to  clear  up  the  position  of  the  National  Catholic 
Welfare  Council  with  reference  to  the  bill. 

Now  there  are  only  two  or  three  points  with  reference  to  the  bill  that  I  want  to  take, 
ixp.  It  has  been  stated  that  this  bill  would  be  used  as  an  instrument  for  the  propaga- 
tion of  the  doctrines  or  practices  of  birth  control.  Now  I  suppose,  Mr.  Chairman,  I 
have  written  as  much  against  birth  control  as  any  nAn  in  this  country.  I  may  say 
I  do  not  believe  in  it  at  all.  I  think  it  is  not  only  immoral  but  means  the  destruction 
of  civilization.  But  I  see  nothing  in  this  bill  which  in  any  vital  way  would  promote 
that  sort  of  teaching. 

It  is  true  that  some  of  the  nurses  or  other  instructors  who  might  be  in  the  employ  of 
the  Children's  Bureau  administering  the  act  would  have  an  opportunity  to  urge  such 
doctrines  and  practices  among  the  people  who  would  come  under  their  ministrations, 
but  that  opportunity  is  already  enjoyed  by  persons  who  are  doing  this  work  for  the 
State  health  bureaus  and  the  city  biu'eaus  of  health,  so  there  is  no  new  method  or  way 
of  propagating  birth-control  doctrines  included  in  this  bill.  The  most  that  can  be 
said  is  that  as  there  would  be  more  persons  engaged  in  this  work;  that  opportunity 
would  be  somewhat  increased.  But  I  take  it  that  the  persons  in  charge  of  the  Chil- 
dren's Bureau  would  be  rather  careful  to  see  that  nothing  of  that  sort  was  done  by  their 
instructors.     At  least  that  is  my  understanding  of  their  attitude  and  temper. " 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  49 

The  second  j)oint  that.  I  ■wanted  to  notice  is  the  eharfje  which  has  been  madt-,  the 
assertion  that  the  principh-  of  this  bill  is  contrary  to  the  Catholic  position  concerning 
the  functions  of  th<!  Stat(>.  I  think  the  persons  who  rnak(»  this  assertion  are  making 
it  without  due  reflection.  It  is  true  that  the  general  Catholic  position  is  that  the 
State  should  keep  its  hands  off  the  family.  That  th(>  interests  of  the  family  are  Ijest 
taken  care  of  by  the  ])arents,  I  subscribe  to  that  doctrine  unreservedly,  not  merely 
because  it  is  the  j^eneral  teaching  of  my  church,  but  because  of  my  studies  in  the 
field  of  political  science.     That  is  the  general  rule. 

In  general  I  think  it  is  Ix'tter  for  individuals  to  do  things  for  themselves  than  to 
have  the  State  do  things  for  them.  It  is  more  democratic,  it  means  more  develop- 
ment of  the  indi\'idual  and  greater  human  ])rogress. 

But  it  is  also  formal  Catholic  teaching  that  when  the  family  is  in  such  straits  or 
in  such  distress  of  one  kind  or  another,  that  this  bad  condition  can  be  relieved  only 
by  State  intervention,  that  then  it  is  not  only  the  right  l)ut  the  duty  of  the  State 
to  intervene.  One  can  find  this  statement  in  almost  so  many  words  in  the  encyclical 
of  Pope  Leo  XIII  on  the  condition  of  labor.  We  also  find  in  that  encyclical  this 
general  statement,  that  whenever  the  common  interest  or  any  particular  class  is 
threatened  with  injury  which  can  in  no  other  way  be  nu^t  or  averted,  it  is  the  duty 
of  the  public  authority  to  intervene.  So  the  only  problem  then  is  concerning  the 
minor  ])roposition.  Is  the  matter  covered  by  this  bill  one  which  is  of  such  urgency 
that  the  State  ought  to  intervene  because  the  persons  who  are  in  distress,  the  families, 
can  not  help  themselves? 

Mr.  Merritt.  Would  you  permit  me  to, interrupt  you  a  moment.  Father? 

Rev.  Dr.  Ryan.  Yes. 

Mr.  Merritt.  You  are  now  stating  that  in  certain  cases  the  State  should  intervene. 
Now  under  our  Constitution  please  bear  in  mind  there  are  two  States. 

Rev.  Dr.  Ryan.  Yes,  sir.  I  am  talking  simply  about  the  general  principles  of 
public  authority. 

Mr.  Merritt.  And  we  all  agree,  I  think,  that  the  State 

Rev.  Dr.  Ryan  (interposing).  Meaning  the  civil  society. 

Mr.  Merritt.  Yes.  We  all  agree,  I  think,  that  the  State,  either  States  or  munici- 
palities, have  in  some  way  a  public  duty  toward  the  family  in  distress. 

Rev.  Dr.  Ryan.  Yes. 

Mr.  Merritt.  Well,  of  course  you  have  here  a  supplementary  question  under  our 
Constitution  as  to  whether  the  United  States  should  intervene  and  take  away  and  limit 
the  responsibility  and  the  action  of  the  States  as  States. 

Rev.  Dr.  Ryan.  Yes. 

Mr.  Merritt.  That  is  the  question. 

Rev.  Dr.  Ryan.  Well,  I  was  simply  addressing  myself  to  the  general  objection  that 
is  made  among  my  own  coreligionists,  some  of  them,  regarding  the  function  of  the 
State,  written  with  a  large  "S,"  public  authority  in  general. 

Mr.  Merritt.  I  agree  with  that  in  general,  but  the  question  is  what  public  authority. 
Now  let  me  ask  you  one  other  question.  Yo'u  are  familiar,- no  doubt,  with  the  Smith- 
Towner  education  bill.  The  broad  principle  of  that  is  that  it  is  essential  for  the  United 
States  to  a.ssist  the  States  in  various  directions.  Did  you  agree  to  the  principles  of  that 
bill? 

Rev.  Dr.  Ryan.  I  think  that  I  did  not.  I  must  say  that  I  have  not  given  it  suiS- 
cient  consideration  to  feel  justified  in  answering  your  question  fully.  I  never  could 
get  quite  as  much  excited  about  it  as  some  people  are,  so  I  decided  that  perhaps  there 
are  other  things  that  I  can  devote  my  attention  to  with  better  results. 

I  may  say,  however,  that  I  think  there  are  large  differences,  possibly  not  of  principle, 
but  certainly  of  policy,  between  the  purpose  and  scope  of  the  Sheppard-Towner  bill  and 
of  the  Smith-Townerbill. 

The  Chairman.  You  say  you  think  the  principles  may  be  the  same? 

Rev.  Dr.  Ryan.  In  a  general  way  I  think  the  principle  is  the  same. 

The  Chairman.  And  do  you  think  the  United  States  Government  can  differentiate 
on  a  matter  of  principle  between  tweedle-dee  and  tweedle-dum? 

Rev.  Dr.  Ryan.  Why,  yes,  Mr.  Chaii-man,  in  this  way.  There  may  be  a  principle 
which  will  justify  the  exercise  of  the  State  in  two  different  fields.  It  may  be  the  same 
principle.  But  there  may  be  a  question  of  policy  as  to  whether  it  may  be  wise  for  the 
State  to  intervene  in  both  fields. 

The  Chairman.  The  United  States,  you  mean? 

Rev.  Dr.  Ryan.  The  United  States,  yes. 

The  Chairman.  Both  are  held  out  as  educational  undertakings? 

Rev.  Dr.  Ryan.  Yes. 

74654—21 4 


50  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

The  Chairman.  The  question  of  whether  you  come  down  this  spoke  of  the  wheel 
for  education  or  down  that  spoke  of  the  wheel  is  eliminated. 

Rev.  Dr.  Ryan.  Yes. 

The  Chairman.  Why,  then,  do  you  see  a  difference  between  the  State  interfering 
in  one  field  and  not  interfering  in  the  other? 

Rev.  Dr.  Ryan.  Well,  there  is  the  primary  difference  that  the  provisions  of  the 
Sheppard-Towner  bill  do  not  involve  any  attitude  toward  or  dealing  with  the  matter 
of  education  in  general.  It  has  one  very  limited  field  of  education,  and  a  field  which 
is  quite  special,  and  has  direct  social  bearing  rather  than  educational  bearing.  It 
is  educational  only  in  a  limited  sense  for  a  larger  social  purpose.  I  do  not  think  we 
can  apply  the  adjective  "educational"  fairly  to  both  proposals  without  reservation, 
without  some  qualification. 

Mr.  Merritt.  Well,  isn't  this  true,  that  you  think  the  principle  is  rather  dangerous, 
but  in  this  case  it  is  not  so  very  dangerous? 

Rev.  Dr.  Ryan.  There  is  something  to  that.  I  think  that  there  is  always  a  danger 
when  the  State,  the  United  States,  or  any  separate  State  enters  a  new  field,  that  the 
thing  may  be  abused.  But  I  take  it  that  experience  justifies  us  in  saying  that  the 
instances  in  which  good  departures  of  that  sort  have  been  abused  are  not  very  large. 
And  that  it  is  up  to  the  Congress  to  see  that  the  thing  is  not  extended  beyond  reason- 
able limits  later  on. 

The  Chairman.  Now,  Father,  let  us  call  brass  t^cks  brass  tacks  and  get  at  this 
thing  as  long  as  it  has  been  introduced.  In  your  testimony  you  have  spoken  of  the 
viewpoint  of  your  church.  • 

Rev.  Dr.  Ryan.  Yes. 

The  Chairman.  And  I  take  no  exception  whatever  to  that.  But  I  would  like  to 
ask  you  if  it  has.  not  likewise  come  to  be  generally  believed  that  the  viewpoint  of 
your  church  on  the  Smith-Towner  bill  is  in  opposition  to  the  bill? 

Rev.  Dr.  Ryan.  Oh,  it  is. 

The  Chairman.  Now  to  that  extent  then  you  naturally  would  not  favor  that  bill, 
and  I  think  you  are  logical.  But  I  would  like  to  ask,  further,  if  it  appears  that  the 
Sheppard-Towner  bill  does  not  incur  the  objection  of  your  church,  and  if  the  differ- 
ence between  the  two  is  not  the  church  view  in  both  instances? 

Rev.  Dr.  Ryan.  I  did  not  catch  the  last  part  of  your  question,  Mr.  Chairman. 

The  Chairman.  My  point  is  this,  that  I  feel  that  you  are  opposed  to  the  Smith- 
Towner  bill  because  of  the  view  of  your  church,  which  we  have  come  to  know  is  a 
definite  objection,  and  we  do  not  argue  that.  If  I  am  right,  you  probably  will  agree. 
Now  when  it  comes  to  the  Sheppard-Towner  bill  you  do  not  have  the  same  chm-ch 
feeling  toward  that  bill,  and  for  that  reason  you  do  not  see  any  cause  for  objecting  to 
it.    And  for  other  reasons  you  see  causes  for  favoring  it. 

Rev.  Dr.  Ryan.  Yes. 

The  Chairman.  So  that  it  looks  to  me,  based  on  your  statement  that  the  principles 
are  virtually  the  same,  that  your  attitude  toward  one  bill  or  tlie  other  bill  is  con- 
siderably affected  from  the  church  point  of  view,  and  of  course  it  would  seem  to  me 
that  the  Congress  of  the  United  States  can  not  differentiate  on  a  matter  of  principle 
in  respect  to  the  views  of  any  one  religion  toward  this  bill,  that  bill,  or  any  other  bill. 

Rev.  Dr.  Ryan.  Perhaps  I  have  not  made  my  position  fully  understood  with 
regard  to  the  Smith-Towner  bill. 

The  Chairman.  We  are  not  trying  to  lead  you  to  destruction,  Father,  at  all. 

Rev.  Dr.  Ryan.  No;  I  will  say  everything  that  is  in  my  mind. 

The  Chairman.  But  in  view  of  the  fact  that  it  has  been  brought  in  by  yoiu:  good 
self  you  can  not  blame  us  for  going  into  that  particular  line  to  see  where  it  fits  in  on 
that  particular  discussion. 

Rev.  Dr.  Ryan.  I  might  observe,  Mr.  Chairman,  that  I  did  not  bring  in  the  Smith- 
Towner  bill  myself.     It  was  brought  in  by  the  Congressman. 

The  Chairman.  Yes;  we  will  grant  that,  we  will  grant  that. 

Rev.  Dr.  Ryan.  I  do  not  tliink  that  I  said  that  my  opposition  to  the  Smith-Towner 
bill  was  based  on  the  attitude  of  the  National  Catholic  Welfare  Council. 

The  Chairman.  No;  I  do  not  tliink  you  did  until  you  were  asked.  Then  you 
admitted  that  you  were  opposed  to  the  bill,  that  your  church  was  opposed  to  the  bill. 

Rev.  Dr.  Ryan.  Oh,  I  admitted  that  I  was  opposed  to  the  bill,  but  I  did  not  say 
that  was  the  only  reason  why  I  was  opposed. 

The  Chairman.  No;  quite  so. 

Rev.  Dr.  Ryan.  As  a  matter  of  fact,  before  the  National  Catholic  Welfare  Council 
made  its  statements  on  the  Smith- Towner  bill,  I  said  occasionally  in  conversation 
that  I  was  opposed  to  it,  that  I  did  not  like  it.  The  differences  between  what  that 
bill  proposes  to  do  and  what  the  Sheppard-Towner  bill  proposes  to  do  are  so  very, 
great  and  have  so  many  ramifications  that  I  do  not  think  we  can  fairly  coinpare  the 
two  by  simply  saying  that  they  both  involve  the  same  principle.     If  they  involved 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  51 

the  same  principle  of  State  subsidy  or  United  States  subsidy  that  might  bo  so,  but  tlie 
Smith-Townor  bill  involves  very  much  more  that  that,  involves  matters  which  ha\e 
no  parallel  in  the  Shoppard-Towner  l)ill,  as  far  as  1  see. 

Now,  just  a  final  word  with  reference  to  the 

Mr.  Graham,  liefore  you  leave  that  may  I  say  a  word? 

The  Chairman.  Mr.  Graham. 

Mr.  Graham.  I  was  struck  with  what  you  said,  Father  Ryan,  al)out  your  belief  in 
the  maintenance  of  the  right  of  the  family  to  govern  itself.  I  agree  with  you  entirely. 
I  think  that  is  most  essential.  But  1  find  in  the  original  act  authorizing  the  estab- 
lishment of  the  ('hildren's  Bureau  this  language: 

"i3ut  no  official  or  agent  or  representative  of  said  bureau  shall,  over  the  objection 
of  the  head  of  the  family,  enter  any  house  used  exclusively  as  a  family  residence." 

No  doubt  that  was  put  in  there  to  cover  the  very  idea  that  you  have  in  mind.  But 
I  do  not  find  in  this  act  here  any  such  limitation;  and  inasmuch  as  this  is  subse- 
quent legislation,  if  it  is  enacted  it  might  be  held  that  that  safeguard  was  not  con- 
tained in  the  law.     Do  you  not  think  it  ought  to  be? 

Rev.  Dr.  Ryan.  Yes;  I  do.  And  my  imderstanding  is  that  that  was  inserted,  and 
that  it  is  in  the  bill  as  recommended  by  the  committee  in  the  Senate. 

The  Chairman.  The  Senate  committee? 

Rev.  Dr.  Ryan.  That  is  my  understanding. 

The  Chairman.  Is  that  true? 

Mr.  Towner.  The  Senate  committee  has  adopted  the  exact  proposition  tliat  the 
gentleman  from  Illinois  calls  attention  to.  Of  course,  there  is  no  ])ossible  oljjection 
to  that.  There  never  was  any  authority  in  the  bill  to  allow  such  interference  mth 
the  family  and  we  are  perfectly  willing  that  the  Senate  amendment  shall  be  adopted 
here. 

Rev.  Dr.  Ryan.  The  last  point  that  I  wanted  to  take  up,  Mr.  Chairman,  is  connected 
with  the  objection  or  point  raised  by  Mr.  Merritt.  The  authority  of  the  Federal 
Government  to  do  this,  and  the  propriety  of  the  Federal  Government  doing  it.  I 
am  not  an  authority  on  this,  and  my  information  is  not  worth  much.  I  do  happen  to 
have  the  conduct  of  a  class  in  political  science  among  my  acti\dties.  I  have  read 
something  along  this  line.  There  seem  to  be  precedents  for  the  use  of  taxation  by 
the  Federal  Government  for  public  purposes  of  this  kind.  We  know  how  much  dis- 
cussion can  be  raised  and  difference  of  opinion  concerning  the  public-welfare  clause 
of  the  Constitution,  concerning  the  phrase  "public  welfare"  in  that  article  of  the  Con- 
stitution which  authorizes  the  Federal  Government  to  levy  taxes.  _  My  understanding 
is  that  the  Supreme  Court  has  never  directly  passed  on  this  question  except  it  would 
be  in  the  sugar  bounty  cases  and  in  one  other  case  which  I  do  not  now  recall.  So  that 
my  opinion  in  this  matter  is  not  worth  anything  as  to  the  constitutionality  of  the 
measure,  and  I  imagine  the  Supreme  Court  will  attend  to  that  eventTially. 

But  the  principle,  or  policy,  rather,  of  a  subsidy  by  the  Federal  Government  to  the 
provincial  or  State  jurisdictions  seems  to  me  to  have  a  great  many  precedents,  and  1 
think  that  the  general  policy  of  the  subsidy  by  a  superior  to  a  subordinate  political 
jmisdiction  on  terms  which  will  insure  the  enforcement  and  proper  administration 
of  the  funds  by  the  subordinate  jurisdiction  helped  is  entirely  a  sound  one  and  a  very 
fruitful  one  in  legislative  and  administrative  action. 

It  seems  to  me  the  important  point  is  that  the  jurisdiction  which  is  helped  should 
have  to  contribute  sufficient  of  its  own  money  to  make  it  worth  while  for  the  subordi- 
nate jurisdiction  to  see  that  the  money  as  whole  is  properly  expended. 

If  that  i^rinciple  is  conserved  in  the  measure— ancl  it  seems  to  me  it  is  conserved  m 
the  Sheppard-Towner  bill— I  do  not  see  any  political  danger  or  any  political  impro- 
priety in  the  general  practice  of  subsidies  of  that  kind. 

I  think  that  is  all  I  have  to  say. 

Mr.  Sanders.  May  I  ask  a  question.  Father  Ryan? 

The  Chairman.  Mj".  Sanders. 

Mr.  Sanders.  Isn't  there  a  great  deal  of  confusion  that  arises  out  of  the  failure  to 
distinguish  between  an  act  which  appropriates  money  for  some  beneficial  purpose  to 
the  countrv  generallv  and  an  act  which  might  be  a  regulation  in  some  wiiy  of  some 
matter  over  which  the  States  usuallv  have  jurisdiction?  Hasn't  our  general  course 
throughout  the  history  of  the  country  followed  along  the  line  of  recognized  constitu- 
tional authority  to  appropriate  monev  for  the  general  welfare  of  the  countr}%  and  after 
the  European  War  did  we  not  go  eveii  outside  of  that  realm  and  appropriate  $100,000.- 
000  to  help  stricken  conditions  in  other  countries?  And  a  mere  appropriation  of  money 
for  a  beneficial  purpose  to  the  citizens  of  the  State  and  the  citizens  of  the  United  States 
is  quite  a  different  proposition  from  legislation  which  undertakes  in  some  way  to  regu- 
late a  matter  within  the  State.  And  isn't  this  very  cleariy  a  proper  exercise  of  the 
constitutional  powers  of  the  Congress? 


52  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Rev.  Dr.  Ryan.  Oh,  I  think  that  it  is.  By  analogy  with  the  decisions  of  the  courts 
where  States  have  done  this  sort  of  thing,  it  seems  to  me  that  we  may  draAV  a  strong 
inference  in  favor  of  the  constitutionality  of  this  kind  of  thing.  The  courts  of  States 
and  the  Supreme  Court  of  the  United  States  in  passing  upon  the  appropriation  of 
money  by  States  for  various  purposes,  have  always  upheld  such  legislation  when  the 
purpose  was  plainly  a  public  one,  and  not  for  a  private  corporation  or  a  group  of  private 
individuals. 

Now  tills  legislation  is  obviously  for  a  public  purpose,  and  as  you  suggest,  there  are 
precedents  in  other  fields  where  taxes  raised  by  the  General  Government  have  been 
so  appropriated. 

Mr.  Ha  WES.  Doctor,  so  that  I  may  understand  the  distinction  that  you  draw 
between  the  principle  of  this  national  maternity  bill  and  the  national  educational 
bill,  what  is  .the  difference?     Is  there  any  difference  in  principle  between  the  two?     • 

Rev.  Dr.  Ryan.  Using  "principle,"  in, the  broadest  sense,  I  do  not  see  any  differ- 
ence. In  both  cases  the  fundamental  principle  is  assistance  of  State  authorities  by 
the  Federal  Government,  for,  let  us  say,  instruction. 

Mr.  Hawes.  The  difference  tlien  is  instruction  in  tie  one  case  regarding  the  mind, 
and  this  bill  is  for  instruction  regarding  the  care  of  the  body;  that  is  the  only  differ- 
ence? 

Rev.  Dr.  Ryan.  Yes,  but  the  instruction  regarding  the  mind,  as  contemplated  in 
the  Smith-Towner  bill,  involves — at  least  many  people  fear  that  it  does — a  vast 
extension  of  power  over  to  the  educational  field  generally,  whereas  the  powers  con- 
ferred on  the  Federal  Government  by  this  bill  are  strictly  limited  to  one  restricted 
and  rather  narrow  field. 

Mr.  Hawes.  Doctor,  would  you  call  the  committee's  attention  to  any  other  national 
law  embodying  this  principle? 

Rev.  Dr.  Ryan.  Well,  the  Smith-Lever  bill  has  been  mentioned,  and  the  bill  for 
vocational  education.  I  think  I  heard  of  another  one.  They  involve  what  I  have 
been  referring  to  as  the  general  principle,  namely.  Federal  subsidy  to  State  authori- 
ties for  the  carrying  out  of  the  work  in  which  the  States  are  primarily  interested, 
and  which  I  am  frank  to  confess  is  primarily  the  business  of  the  States  and  local  juris- 
dictions. 

But  again,  it  is  a  question  of  whether  the  public  welfare  may  not  be  better  pro- 
moted by  giving  assistance  and  stimulus  from  the  Federal  Government  when  the  States 
and  local  jurisdictions  are  not  satisfactorily  performing  their  native  functions. 

Mr.  Hawes.  Doctor,  the  exercise  of  this  function  by  the  various  States  is  usually 
confined  to  the  health  corps  or  health  departments  of  the  States,  is  it  not? 

Rev.  Dr.  Ryan.  Yes,  sir. 

Mr.  Hawes.  Now,  this  control  is  placed  in  the  Department  of  Labor  of  the  United 
States. 

Rev.  Dr.  Ryan.  Yes. 

Mr.  Hawes.  Do  you  find  any  inconsistencies  in  that.  Doctor? 

Rev.  Dr.  Ryan.  Why,  I  should  say  that  it  would  be  inconsistent  if  the  administra- 
tion of  this  act  were  in  the  hands  of  the  Secretary  of  Labor  directly,  because  when  we 
think  of  the  Secretary  of  Labor,  the  Labor  Department,  we  think  of  industrial  matters. 
We  think  particularly  of  matters  pertaining  to  the  welfare,  I  suppose,  of  the  wage- 
earning  classes.  But  the  authority  which  is  to  have  charge  of  this  bill  is  a  bureau  in 
the  department,  the  Children's  Bureau.  A  bureau  which  has  a  considerable  measure 
of  autonomy,  at  any  rate,  whose  field  is  rather  definite^ly  limited,  and  the  activities 
of  that  bureau  have  been  quite  harmonious  with,  quite  of  the  same  general  nature, 
as  the  activities  which  are  to  be  carried  on  under  the  aid  and  encouragement  of  the 
provisions  of  this  bill.  Having  to  do  with  child  life,  child  welfare,  and  the  children 
general^ly. 

I  should  say  that  the  functions  of  the  Children's  Bureau  have  been  in  the  main 
social  rather  than  industrial,  therefore  I  do  not  see  the  incongruity,  Mr.  Congressman, 
which  you  suggest,  between  the  administration  of  the  bill  for  this  purpose  and  the 
Department  of  Labor  as  the  administrator. 

Mr.  Hawes.  I  was  much  interested.  Doctor,  in  the  first  witness  that  appeared 
who  divided  the  causes  of  child  laws  into  three  classes:  Economic,  social,  and  medi- 
cinal, I  believe.  Are  you  familiar  with  that  classification?  Do  you  agree  to  it,  to  its 
importance? 

Rev.  Dr.  Ryan.  Yes;  I  think  that  it  is  important.  I  think  that  it  covers  substan- 
tially the  ground  of  all  of  the  causes.  You  say  economic,  social,  and  medicinal  or 
hygienic? 

Mr.  Hawes.  Yes. 

Rev.  Dr.  Ryan.  I  should  say  that  ought  to  be  a  complete  classification  of  causes. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  53 

Mr.  IIawes.  Well,  what  ])roi)ortion  do  you  think,  for  instance,  the  economic  would 
bear  to  the  social  and  the  medicinal?  Would  it  be  one-third  or  one-half,  or  what 
per  cent?  * 

Rev.  Dr.  Ryax.  Well,  most  of  my  life  I  have  been  interested  in  economic  problems, 
and  my  predisposition  would  be  to  emphasize  the  economic  factor  as  the  most  im- 
portant. But  I  do  not  know  enouirh  about  lh(!  facts  as  disclosed  by  a<'tual  investiga- 
tion to  warrant  nic  in  attcmj)tin<,'  to  ap])ortion  the  causality  amoiiir  these  three  factors. 
I  see  reasons  why  I  think  the  economic  factors  are  more  important  than  any  of  the 
others,  but  I  am  not  certain. 

Mr.  IIawes.  You  would  not  attempt  to  classify  the  proportions? 

Rev.  Dr.  Ryan.  No:  I  would  not  attempt  to  classify  the  proportions. 

Mr.  >SwEET.  Mr.  Chairman. 

The  Chairman.  Mr.  Sweet. 

Mr.  Sweet.  Do  you  believe.  Father,  that  the  demand  for  Federal  aid  and  advice 
should  come  from  the  States,  throu<?h  the  j)eople  of  the  States? 

Rev.  Dr.  Ryax.  The  States? 

Mr.  Sweet.  Yes:  that  that  demand  should  come  from  the  States? 

Rev.  Dr.  Ryax.  I  should  think  the  existence  of- such  demand  would  be  the  best 
test  we  could  have  of  the  necessity  of  such  lesislation. 

Mr.  Sweet.  Xow  in  what  form  should  that  demand  come,  do  you  believe? 

Rev.  Dr.  Ryax.  Well,  I  have  not  thougrht  of  that.  I  do  not  know  how  to  answer 
it  adequately.  In  <i:eneral  we  know  that  the  demand  for  legislation  of  one  kind  or 
another  comes  from  various  sources.  A  large  part  of  the  demand  is  sometimes  fostered 
by  i)rivate  persons,  private  associations.  It  is  only  rarely  that  we  can  say  that  a 
demand  comes  for  Federal  legislation  from  the  States  in  the  sense  of  coming  from  the 
representative  authorities  of  the  people  in  the  States,  that  is,  the  State  legislators. 
I  think  that  is  rather  rare.  Now  when  tlie  demands  come  from  organizations  or  persons 
within  the  State,  or  within  the  several  States,  I  suppose  we  have  to  apply  the  ordinary 
tests  to  them  to  determine  Avhether  these  indi\iduals  and  associations  really  represent 
the  people.  Whether  they  can  be  said  to  be  speaking  for  the  State.  It  is  pretty 
difficult  to  determine  that. 

Mr.  Sweet.  I  believe  we  can  agree  that  the  demand  should  come  from  the  people 
of  the  States  for  legislation  of  this  kind. 

Rev.  Dr.  Ryax.  Yes:  I  think  so. 

Mr.  Sweet.  Now  I  am  asking  these  questions  in  \dew  of  the  statements  made  by 
others  who  have  appeared  here  before  the  committee.  For  instance,  it  is  stated  by 
those  who  have  appeared  from  New  York,  that  as  far  as  New  York  City  is  concerned 
this  legislation  %\'ill  not  particularly  benefit  them  in  any  way. 

Now  then,  naturally  we  come  to  the  conclusion  or  line  of  thoiight:  What  demand 
is  there  for  this  legislation  coming  from  the  several  States,  the  Western  States,  the 
Southern  States?  What  are  the  conditions  in  those  States  in  regard  to  the  question 
that  is  involved  in  this  bill? 

Now,  can  you  give  me  any  facts  or  statistics  relative  to  the  demands  that  are  arising 
from  the  several  States  for  this  class  of  legislation? 

Rev.  Dr.  Ryax.  I  am  afraid  that  I  can  not,  Mr.  Congressman;  and  I  may  add  here 
that  I  have  been  rather  reluctant  to  appear  on  behalf  of  this  bill  because  of  my  lack 
of  adequate  familiarity  with  the  whole  subject.  All  that  I  know  is  that  the  need 
exists  which  this  bill  is  intended  to  meet,  and  that  I  belieA'e  that  this  is  a  proper 
wav  of  meeting  it. 

On  the  question  of  the  amount  of  demand  that  exists  for  it  and  the  disposition  of 
that  demand  throughout  the  country,  I  am  afiaid  I  can  not  contribute  any  knowledge. 

Mr.  Sweet.  So  that  my  attitude  toward  the  bill  many  not  be  misunderstood,  I 
have  a  very  friendly  attitude  toward  the  bill,  but,  of  course,  in  passing  upon  those 
questions  it  becomes  impoitant  to  know  what  is  demanded  from  the  several  States, 
the  nature  of  that  demand,  the  conditions  existing  in  the  State  upon  the  question 
involved  in  the  bill.  All  those  things  become  material  in  coming  to  a  proper  con- 
clusion as  to  the  necessity  of  this  legislation.     I  think  that  is  all. 

Mr.  Cooper,  ilr.  Chairman. 

The  Chairmax.  Mr.  Cooper. 

Mr.  Cooper.  Doctor,  I  am  moved  to  ask  your  opinion  on  this  matter  by  reason  of 
1  question  that  was  asked  you  a  few  moments  ago.  That  question  was:  Do  you 
Oelieve  that  the  Department  of  Labor  should  have  charge  of  this  bill?  Now,  section  3 
)f  this  bill  directs  the  chief  of  the  Children's  Bureau — it  does  not  request — it  directs 
,hat  the  chief  of  the  Children's  Bureau  shall  fonh  an  advisory  committee,  which  is 
:;omposed  of  the  Secretary  of  Agriculture,  the  Surgeon  General  of  the  United  States 
Public  Health  Service,  and  the  United  States  Commissioner  of  Education,  to  assist 
n  carrying  on  this  work.  Now,  I  want  your  opinion  on  this  matter.  Do  you  not 
)elieve  that  when  this  question  of  the  cairjdng  out  of  this  act  is  placed  into  the  hands 


54  PUBLIC   PKOTECTION   OF   MATERNITY  AND  INFANCY. 

of  that  committee,  the  advisory  committee  with  the  chief  of  the  Children's  Bureau, 
that  it  is  a  question  that  is  not  entirely  in  the  hands  of  the  Department  of  Labor? 

Rev.  Dr.  Ryan.  Of  course,  everythiri^-  depends  on  how  much  consideration  the 
head  of  the  Children's  Bureau  would  give  to  her  advisers.  But  as  such  advisory 
boards  function  generally,  I  should  say  that  the  opinions  and  the  judgments  of  the 
three  advisers  would  receive  considerable  weight.  I  think  that  is  the  result  always 
of  advisory  boards  that  are  formally  established  by  law.  I  am  merely  giving  my 
general  impression  as  to  how  these  things  work.  I  have  nothing  more  definite  to 
offer. 

Mr.  Mapes.  Mr.  Chairman. 

The  Chairman.  Mr.  Mapes. 

Mr.  Mapes.  Father,  in  that  connection,  do  you  think  it  is  fundamental  what  depart- 
ment of  government  this  is  under? 

Rev.  Dr.  Ryan.  Oh,  no;  I  don't  think  there  is  any  fundamental  principle  involved, 
sir.     It  is  a  question  of  administration  entirely. 

Mr.  Mapes.  And  its  success  or  failure  will  depend  upon  the  people  who  are  put  in 
charge  of  its  administration? 

Rev.  Dr.  Ryan.  Apparently;  yes. 

Mr.  Mapes.  The  attention  of  several  witnesses  has  been  called  to  the  apparent 
inconsistency  of  putting  it  in  a  bureau  which  is  now  in  the  Department  of  Labor. 
There  is  abundance  of  precedence  throughout  the  Government  for  inconsistencies  of 
that  kind. 

Rev.  Dr.  Ryan.  Well,  they  are  all  to  be  cleared  up  and  abolished,  I  believe,  before 
many  months,  or  years,  perhaps. 

Mr.  Mapes.  That  is  the  fond  hope  of  soine. 

Mr.  Towner.  Father  Ryan,  some  questions  have  been  asked  you  based  upon  the 
assumption  that  this  bill  transfers  the  control  of  these  matters  from  the  States  to  the 
General  Government.  Do  you  know  whether  there  is  anything  in  this  bill  that 
transfers  the  control  from  the  States  to  the  General  Government? 

Rev.  Dr.  Ryan.  No;  I  do  not  know  anything  in  the  bill  that  does  that.  In.  fact, 
I  have  read  the  bill  rather  carefully  in  order  to  find  whether  there  was  anything  of 
that  sort  there.  But,  Judge  Towner,  I  do  not  understand  that  any  of  the  questions 
stated  that,  or  even  strongly  implied  it.  One  question  was  so  worded  that  I  was  afraid 
that  that  was  coming,  but  it  did  not. 

Mr.  Towner.  Another  question  was  based  upon  the  assumption  that  this  children's 
bureau  by  the  terms  of  this  bill  was  to  exercise  the  authority  within  the  States  with 
regard  to  the  matters  that  the  bill  refers  to.  Is  there  anytMng  in  the  bill  that  does 
that? 

Rev.  Dr.  Ryan.  No;  I  should  say  that  the  direction  over  the  activities  which  the 
money  appropriated  by  the  bill  is  intended  to  further  is  left  entirely  in  the  hands  of 
the  local  authorities. 

Mr.  Rayburn.  Mr.  Chairman,  may  I  ask  a  question? 

The  Chairman.  Mr.  Rayburn. 

Mr.  Rayburn.  Is  it  a  violent  assumption  to  say  that  the  Federal  Government  will 
at  least  ultimately  take  charge  of  this  matter  entirely,  in  the  light  of  what  they  have 
done  in  other  matters  along  this  line?  Take  the  road  proposition.  The  other  day 
they  passed  an  amended  road  act  here  that  says  that  before  my  State  shall  participate 
in  any  of  the  funds  whatever  it  must  amend  the  constitution  of  that  State. 

Mr.  Towner.  Do  you  say  the  law  says  that? 

Mr.  Rayburn.  The  law  says  that. 

Mr.  Towner.  No;  I  beg  your  pardon. 

Mr.  Rayburn.  The  laws  of  my  State- — — 

Mr.  Towner.  I  beg  your  pardon. 

Mr.  Rayburn.  It  did  not  name  the  State  of  Texas. 

Mr.  Towner.  The  assumption  is  on  the  part  of  some  gentlemen  from  Texas  that  in 
order  to  take  advantage  of  natural  law  it  would  require  changing  the  constitution  of 
the  State.     I  don't  know  whether  that  is  true  or  not. 

Mr.  Rayburn.  Well,  it  is  exactly  true,  because  the  provision  in  our  constitution 
is  that  the  State  can  make  appropriations  for  improvements,  and  that  is  what  it  has 
got  to  do  under  that  law. 

Mr.  Towner.  That  is  an  inference. 

Mr.  Rayburn.  Why,  it  is  certainly  the  law  that  the  State  must  make  appropriation 
direct  through  legislation. 

Mr.  Towner.  But,  Mi'.  Rayburn*  you  stated  that  the  law  provided  that  you  would 
have  to  change  the  constitution  of  your  State. 

Mr.  Rayburn.  I  say  that  is  so,  because  there  is  a  provision  in  the  bill  which,  if 
carried  out,  would  necessitate  the  change  before  the  State  can  participate. 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  55 

Rev.  Dr.  Ryan.  Attempting,'  to  answer  your  questi(m  so  far  as  I  can,  Mr.  Congress- 
man, it  is  possible  that  the  Federal  Government  might  some  day  take  charge  of  that 
work  if  the  Constitution  should  be  changed  in  order  to  permit  it.  It  8eem.s  to  me  that 
there  would  have  to  be  an  amendment  to  the  Con.stitutiou  in  order  to  enable  the 
Federal  Government  formally  and  directly  t(j  go  into  the  business  of  ])romoting  the 
welfare  of  the  mothers  and  babies  provided  for  in  this  bill,  to  take  charge  of  it. 

Mr.  Rayuurn.  The  older  lawyers  never  argued  that  the  welfare  clause  of  the 
Constitution  was  a  grant  of  power,  but  recently  lawyers  have  begun  most  seriously  to 
argue  that  the  welfare  clause  of  the  Constitution  is  a  grant  of  power. 

Rev.  Dr.  Ryan.  They  have  not  got  very  far  as  yet. 

Mr.  Rayburn.  Well,  they  have  passed  laws  on  that  subject.  I  don't  know  what  the 
Supreme  Court  will  do. 

Mr.  Hawks.  Doctor,  under  this  bill  each  State  is  permitted  to  have  $10,000  and 
then  a  certain  proportion  of  a  million  dollars.  Is  it  your  understanding  that  this 
$10,000  of  the  money  that  goes  to  the  State  is  to  be  spent  by  the  State  without  any 
supervision  or  direction  or  limitation  placed  upon  it  by  the  Federal  board? 

Rev.  Dr.  Ryan.  No;  I  do  not  understand  that.  There  is  at  least  general  supervision 
by  the  Federal  board. 

Mr.  Towner.  Section  4  provides  that,  in  order  to  secure  the  benefits  of  the  appro- 
priation authorized  in  section  2  of  this  act  it  must  be  accepted  by  the  legislative 
authority  of  the  State. 

Mr.  Rayburn.  Is  that  all — just  an  acceptance  of  the  $10,000  in  our  appropriation? 
Is  that  the  only  thing  that  the  State  agency  has  to  do? 

Mr.  Towner.  Well,  it  must  accept  the  provisions  of  this  act. 

Mr.  Rayburn.  You  do  not  understand  me,  Mr.  Towner.  Under  Federal  aid  for 
roads,  which  is  an  entirely  different  principle  from  this  bill,  the  principle  is  not 
in  dispute  in  any  way;  the  State  first  matches  the  Federal  money.  Now,  your  bill 
provides  for  that,  of  course? 

Mr.  Towner.  Not  for  the  $10,000. 

Mr.  Rayburn.  Not  for  the  $10,000,  but  for  any  additional  money? 

Mr.  Towner.  Yes. 

Mr.  Rayburn.  Now,  the  Federal  aid  for  roads  places  a  limitation  on  the  use  of 
Federal  money  in  the  State  providing  that  roads  shall  be  built  to  a  certain  width,  of 
a  certain  material.  They  shall  be  maintained,  they  shall  be  connected,  and  there 
are  a  great  many  restrictions  placed  upon  the  use  of  the  Federal  money.  Now,  what 
are  the  restrictions? 

Mr.  Towner.  I  am  very  glad  you  called  attention  to  that,  Mr.  Rayburn.  I  will 
1  speak  about  that,  however,  later.  The  restrictions  are  entirely  different  with  regard 
to  this  bill.  The  only  restriction  that  there  is  with  regard  to  this  bill  is  that  there 
,  shall  be  some  authority  in  the  State  which  the  legislature  of  the  State  shall  provide 
;to  administer  this  law.  It  may  be,  and  possibly  would  be,  in  the  majority  of  cases, 
'the  public-health  service  of  that  State;  or  if  it  has  a  child- welfare  service,  it  would  be 
[placed  within  that  service.  Now,  this  child-welfare  service  or  the  public-health 
service,  pro\dded  that  is  the  authority  to  act  under  the  provisions  of  this  act,  vriU  make 
application  for  these  funds,  for  their  share,  to  the  Children's  Bureau  here  in  Washing- 
ton, stating  how  they  expect  to  use  these  funds  for  the  specific  pui'poses  specified  in 
this  bill. 

Mr.  Graham.  Judge  Towner,  I  would  like  to  hear  you,  but  I  am  unable  to. 

The  Chairman.  Won't  you  please  face  the  committee.  Judge? 

Mr.  Towner.  And  then  if  the  Public  Health  Service  assures  the  biueau  here  that 
the  funds  are  to  be  used  for  the  particular  purposes  that  are  specified  in  the  Vjill,  the 
administrative  featm-es  of  the  act  are  left  entirely  with  the  State.  Then  they  are  to 
receive  the  funds  and  they  are  to  administer  them.  There  is  no  control,  no  adminis- 
trative control  over  the  expenditure  of  the  fund,  and  there  are  no  limitations  such  as 
you  suggest,  such  as  are  in  the  road  bill,  the  simple  requisite  being  that  they  are  to  be 
used  for  the  purposes  specified  in  this  act. 

Mr.  Hawes.  We  will  say  that  the  State  of  Arkansas,  Judge,  has  a  health  department 
and  embodies  this  maternity  and  child-welfare  principle  in  their  law,  l:)Ut  the  method 
of  operation,  its  plan,  its  scope,  do  not  agree  with  the  national  idea;  do  you  mean  to 
3ay  that  the  Federal  Government  would  give  to  Arkansas  its  $10,000  and  its  proportion 
of  the  81,000,000  without  regard  to  any  other  question  than  the  question  of  matching 
the  money? 

Mr.  Towner.  No;  they  would  Jaave  to  determine  that  this  money  was  to  be  used 
for  the  particular  purpose  specified  in  this  act.    That  is  definite. 

Mr.  Hawes.  But  the  manner  of  using  it? 

Mr.  Towner.  The  manner  of  using  it  would  not  be  interfered  \\ith,  regulated,  nor 
controlled  in  Washington. 


56  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

Mr.  Ha  WES.  That  would  be  controlled  by  the  State? 

Mr.  Townee.  That  would  be  controlled  by  the  State. 

Mr.  Hawes.  Then  what  degree  of  regulation  does  the  National  Government  have 
over,  we  will  say,  the  State  of  Arkansas? 

Mr.  Towner.  It  hasn't  any,  except  to  see  that  the  money  that  is  to  be  appropriated 
from  the  General  Government  shall  be  used  for  the  specific  pm'pose  herein  stated. 

The  Chairman.  Mr.  Hawes,  will  you  pardon  an  interruption?  May  I  refer  you 
to  section  8  of  the  bill,  in  connection  with  the  inquiry  that  we  are  now  making,  that 
you  may  see  what  the  explanation  is? 

Mr.  Hawes.  Before  I  look  at  that  section,  Mr.  Towner 

Mr.  Towner  (interposing).  Gentlemen,  would  it  not  be  well  to  defer  this  to  some 
other  time?  These  witnesses  are  anxious  to  go,  and  if  we  can  dispose  of  them  we 
can  have,  as  I  suggested  yesterday,  ample  time  to  take  the  matter  up  and  discuss  it; 
and  if  there  is  anything  in  this  bill — as  some  gentlemen  seem  to  infer  that  this  bill  is 
adamant,  that  it  can  not  be  changed,  you  are  here  to  change  it.  If  there  is  anything 
that  leads  to  control  of  authority  or  anything  of  that  kind  in  this  bill  that  you  do  not 
approve  of,  change  it.  You  will  not  find  any  objection  on  my  part  or  on  the  part  of 
the  supporters  of  this  bill  to  that.  They  only  want  to  aid  and  encourage  and  stimulate 
activity  in  these  directions. 

Mr.  Hawes.  Mr.  Chairman,  I  submit  that  in  my  opinion  there  is  not  a  man  on  this 
committee — I  assume  there  is  not — that  is  not  interested  in  the  objects  sought  by 
this  bill;  furthermore,  there  is  no  objection,  but  I  think  from  my  conversations  they 
are  favorable,  to  its  administration  by  women,  but  the  questions  I  am  asking  now  are 
the  real  questions  we  want  to  have  answered  about  this  measure. 

Mr.  Townee.  I  am  not  criticising  you  for  asking;  my  suggestion  is  that  these 
questions  that  are  not  under  consideration  by  these  particular  witnesses  had  better 
be  deferred  so  that  we  can  get  through  with  these  witnesses. 

Mr.  Hawes.  Now,  Mr.  Towner,  you^are  familiar ^ — I  was  talking  to  the  witness  and 
•you  sought  to  testify  yourself. 

Mr.  Towner.  No;  1  was  asking  the  witness  questions,  Mr.  Hawes. 

Mr.  Hawes.  I  would  like  to  ask  you  one  question  before  we  get  off  of  this  subject. 

The  Federal  aid  law  was  passed  in  1916,  the  measure  of  national  control. 

Mr.  Towner.  "\ATiich  one? 

Mr.  Hawes.  The  Bankhead  bill. 

Mr.  Towner.  You  mean  the  vocational  bill? 

Mr.  Hawes.  No;  the  road  law.  And  already,  in  1920,  Mr.  Townsend  in  the  Senate 
has  a  bill  with  a  large  propaganda  back  of  it,  which  \irtually  gives  the  United  States 
control,  if  his  bill  passes,  over  70  per  cent  of  the  road  mileage.  In  other  words,  the 
bill  started  in  like  a  lamb  in  1916  and  now  there  is  a  movement  for  national  control, 
absolutely.     You  are  familiar  with  that,  aren't  you? 

Mr.  Towner.  Yes.     Are  you  in  favor  of  the  Townsend  bill? 

Mr.  Hawes.  No,  sir;  I  am  not. 

Mr.  Towner.  Neither  am  I.  Because  somebody  introduces  a  bill  that  has  no  merit 
is  certainly  not  an  argument  against  a  proposition  that  has  some  merit. 

Mr.  Hawes.  The  object  of  my  questions,  Mr.  Towner,  is  not  to  injure  this  bill,  but 
to  secure  a  meeting  of  minds,  if  possible,  and  to  make  it  quite  clear  that  there  shall  be 
no  national  control  of  local  State  agencies,  and  the  only  way  that  I  can  arrive  at  a  con- 
clusion, is  to  question  you  ladies  and  gentlemen  as  to  what  the  intent  is. 

Mr.  Towner.  Do  you  think  that  in  this  bill,  supported  by  these  women  all  over  the 
United  States,  that  they  have  either  any  purpose  or  desire  or  wish  to  place  in  a  central 
bureau  here  at  Washington  the  control  of  this  matter?  Is  it  not  plain  to  you  that  all 
that  they  do  desire  is  to  aid  and  stimulate  the  States  to  activity  upon  these  lines? 

Mr.  Hawes.  It  is  not  quite  clear,  no;  Mr.  Towner. 

Mr.  Towner.  I  am  quite  sure,  Mr.  Hawes,  that  it  will  be  before  you  get  through 
with  your  examination  of  these  witnesses. 

Mr.  Hawes.  I  trust  and  hope  so;  but  it  can  only  be  made  clear  by  the  testimony 
of  witnesses. 

Mr.  Towner.  Certainly.     I  understand  that. 

Mr.  Barkley.  Dr.  Ryan,  I  did  not  hear  all  of  your  testimony.  Did  you  state  to  the 
committee  whether  you  thought  the  Children's  Bureau  is  the  proper  governmental 
agency  to  operate  this  law? 

Rev.  Dr.  Ryan.  I  think  that  the  Children's  Bureau  is  the  proper  agency  of  adminis- 
tration at  present. 

Mr.  Barkley.  Of  course  that  is  all  subject  to — not  necessarily  so,  but  might  be 
subject  to — any  reorganization  of  the  departments. 

Rev.  Dr.  Ryan.  Precisely. 


PUBLIC   PEOTECTION   OF   MATERNITY  AND   INFANCY.  57 

Mr.  Barkley.  l?ut  even  under  a  reorganization,  either  the  present  Children's 
Bureau  or  some  other  children's  bureau  created  by  the  reorganization  would  be  the 
proper  agency,  you  think,  to  administer  this  act? 

Rev.  Dr.  Ryan.  I  think  so.  The  only  competing  agency  that  I  think  is  worthy 
of  consideration  would  be  the  Public  Health  Service,  and  I  don't  know  enough  about 
that  to  say. 

Mr.  Barkley.  If  the  Public  Uealth  Service  were  given  the  administration  of  this 
act,  the  Public  Health  Service  being  largely  a  medical  organization,  would  it  not 
give  color  to  the  claim  of  some  of  those  who  oppose  this  bill,  that  it  would  be  a  step 
towards  compulsory  medical  attention  given  by  the  Government? 

Rev.  Dr.  Ryan.  I  have  no  doubt  that  it  would. 

Mr.  Barkley.  Would  that  not  also  give  color  to  the  objections  that  some  people 
are  raising  that  it  would  give  governmental  sanction  and  authority  to  a  certain  par- 
ticular school  of  medicine? 

Rev.  Dr.  Ryan.  Precisely. 

Mr.  Barkley.  That  is  all  I  have  to  ask. 

Mr.  Towner.  Mr.  Chairman  1  will  ask  Mr.  Edward  McGrad)^  who  is  the  national 
legislative  representative  of  the  American  Federation  of  Labor,  to  take  the  stand. 

STATEMENT  OF  MR.  EDWARD  S.  McGRADY,  NATIONAL  LEGISLA- 
TIVE REPRESENTATIVE  AMERICAN  FEDERATION  OF  LABOR, 
WASHINGTON,  D.  C. 

Mr.  McGrady.  Mr.  Chairman,  I  desire  to  submit  for  the  record  these  resolutions 
that  were  adopted  at  our  last  convention  in  Denver,  held  in  June. 

Mr.  Rayburn.  Mr.  Chairman,  I  would  like  to  know  from  this  witness  before  he  goes 
on  just  whom  he  represents.     Do  you  represent  the  American  Federation  of  Labor? 

Mr.  McGrady.  Yes,  sir. 

Mr.  Rayburn.  \Miat  is  your  business?  Wha,t  was  your  business  before  you  were 
that  representative?     Were  you  a  doctor? 

Mr.  McGrady.  What  was  my  business? 

Mr.  Rayburn.  Yes. 

Mr.  McGrady.  No;  I  was  a  plain  wage  earner,  a  common  ordinary  tradesman. 

Mr.  Rayburn.  I  just  wanted  to  find  out  what  your  business  was. 

Mr.  McGrady.  Printer;  and  am  qualified  to  speak  as  father  and  grandfather. 

Mr.  Towner.  Your  home  is  in  Boston? 

Mr.  McGrady.  My  home  is  in  Boston. 

Mr.  Barkley.  You  do  not  mean  that  you  are  a  gi-andfather  now? 

Mr.  McCtrady.  rositively.     [Laughter.] 

Mr.  ("hairman,  I  would  like  to  present  for  the  record  these  resolutions  adopted  by 
the  American  Feder.ition  of  Labor  at  its  last  convention  in  Denver  from  June  13  to 
June  25.     These  resolutions  were  adopted  by  the  convention  unanimously. 

The  Chairman.  Without  objection,  they  will  be  inserted  at  this  point. 

(The  resolutions  re  erred  to  follow:) 

"resolution  no.  102. 

'[By  Dele,?ate  James  J.  Forrester,  Brotherhood  of  Railway  and  Steamship  Clerks,  Freight  Handlers, 

Express  and  Station  Employees.] 

"\\Tiereas  a  bill  commonly  known  as  the  Sheppard -Towner  maternity  bill  has  been 
introduced  in  both  Houses  and  is  now  before  the  Congress  of  the  United  States  for 
consideration  and  action;  and 
•'Whereas  this  bill,  if  enacted  into  law,  will  promote  scientific  care  (medical  and 
nursing)  to  mother  and  child   prior  to,  during,  and  following  childbirth     t  the 
expense  of  the  Federal  and  State  Governments;  and 
"Whereas  such  scientific  care  will  materially  reduce  the  death  rate  of  mothers  during 
the  maternity  period  and  of  child  en  'stillborn  "  and  of  those  who  die  within  a  short 
period  after  birth,  the  number  of  which  is  now  enormous  and  appalling: 
"Resolvcfl,   By  the  delegates  to  this  the    Forty-first  Annual  Convention  of   the 
American  Federation  of  Labor,  assembled  at  Denver,  Colo.,  that  we  most  earnestly 
indorse  the  said  Sheppard-Towner  maternity  bill  and  urge  upon  Congress  its  enact- 
ment into  law;  and,  further,  be  it 

'' Resohed,  That  the  executive  council  of  the  American  Federation  of  Labor  be, 
and  is  hereby,  instructed  to  make  every  elVort  and  use  all  available  means  to  carry 
out  the  purposes  of  this  resolution,  to  the  end  that  this  meritorious  and  humanitarian 
proposed  law  be  passed  by  the  Congi-ess,  signed  by  the  President,  and  made  operative 
within  the  several  States. 

"The  committee  concurs  in  the  resolution  and  recommends  its  adoption." 


58  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Mr.  McGrady.  I  want  to  say,  Mr.  Chairman,  that  the  impression  seems  to  have 
gotten  around  in  some  quarters  that  the  maternity  and  infancy  bill  was  largely  a 
woman's  bill.  That  is  not  so.  It  is  a  man's  bill  just  as  much  as  a  woman's  bill. 
I  do  not  suppose  that  there  is  any  class  in  the  world  where  the  man — or  rather  the 
husband  and  wife — are  closer  together  and  have  more  in  common  than  is  the  wage 
earner  and  his  wife.  They  have  to  go  through  all  kinds  of  trials  and  tribulations 
together,  not  very  far  removed  from  the  poorhouse  many  times.  She  goes  hungry 
when  he  does  not  work,  and  if  anything  happens  to  her  it  means  disaster  to  him, 
and  many  times  she  has  to  go  out  and  work  with  him  in  order  to  feed  the  children. 
And  we  know  in  the  American  Federation  of  Labor  that  the  man  who  is  the  most 
poorly  paid,  generally  the  little  white  hearse  draws  up  to  his  door  more  often  than 
to  the  door  of  the  man  who  is  better  paid.  And  we  know  that  in  a  great  many  cases 
— we  know  because  we  generally  pay  death  benefits  and  we  generally  have  sick 
benefits,  and  those  who  are  extremely  poor  we  assist  financially — and  we  know  that 
too  often  amongst  the  poorly  paid  workers  the  women  are  prone  to  die  during  child- 
birth, and  we  know  that  in  a  great  many  cases  their  children  are  liable  to  die  before 
the  first  year.  We  have  tried  to  assist  them  in  our  feeble  way,  as  best  we  could, 
and  we  have  hoped  and  prayed  and  worked  for  a  long  time  for  the  passage  of  this 
kind  of  a  bill  that  might  help  the  American  worker  to  keep  his  wife  with  him,  and 
might  help  enable  his  children  to  live  after  his  wife  bears  them. 

I  do  not  know  that  there  is  anything  else  that  I  can  go  into  that  has  not  already 
been  covered  by  previous  speakers,  but  we  in  the  American  Federation  of  Labor, 
with  over  4,500,000  workingmen,  trust  that  this  committee  will  report  out  this  bill, 
and  we  trust  the  Congress  will  pass  it.     It  is  a  badly  needed  mesaiu"e. 

The  Chairman.  Are  there  any  questions  to  ask  of  Mr.  McGrady? 

Mr.  Denison.  As  I  understand  from  your  testoimny,  the  question  is  largely  an 
economic  one.  You  have  been  emphasizing  the  fact  that  this  work  is  needed  among 
the  lower  paid  wage  earners. 

Mr.  McGrady.  Yes. 

Mr.  Denison.  So  that  from  your  point  of  view  it  is  largely  an  economic  question? 

Mr.  McGrady.  I  believe  that  the  economic  side  is  a  very  important  one  "in  this 
matter.  Of  course  I  also  will  say  that  among  the  poorer  people  they  need  education 
along  these  lines.  They  have  not  had  it;  they  do  not  understand  it;  they  have  never 
had  the  opportunity.  If  their  men  were  higher  paid,  the  higher  wages  would  allow 
them  to  get  better  medical  attention,  to  get  better  education  along  those  lines. 

Mr.  Denison.  Have  you  considered  at  all  or  studied  at  all  the  system  in  some  of 
the  European  countries  for  maternity  benefits? 

Mr.  McGrady.  No;  I  have  not  done  that.  I  will  say  this,  and  I  would  like  to  point 
this  fact  out  to  the  gentleman:  Something  was  said  the  other  day  about  the  large 
percentage  of  deaths  during  childbirth  among  the  foreigners.  I  want  to  tell  you  gentle- 
ment  that  the  death  rate  is  deplorable  among  the  old  American  stock  in  Tural  districts 
in  this  country.  I  have  in  mind  the  Americans  for  generations  in  the  mining  dis- 
tricts up  through  West  Virginia — -yes,  and  in  Tennessee  and  out  through  the  Middle 
West.  I  recall  one  case  distinctly,  because  I  slept  in  the  cabin  that  night,  where 
they  tried  to  get  a  doctor  and  it  took  the  doctor  14  hom's  to  come  over  the  mountains 
on  horseback.     Before  he  arrived  both  the  mother  and  her  baby  were  dead. 

Mr.  Graham.  This  bill  will  not  help  any  in  such  cases  as  that. 

MJr.  McGrady.  This  bill  would  allow  the  mother  to  be  properly  educated  before 
she  reached  that  crisis. 

Mr.  Graham.  It  will  do  that,  but  when  the  critical  time  comes  and  the  child  is  to 
be  born,  this  does  not  help. 

Mr.  McGrady.  Undoubtedly  that  is  true  but  it  is  also  true  as  this  physician  said, 
that  had  the  woman  received  proper  nourishment  and  had  the  woman  received  proper 
care,  she  would  not  have  died. 

Mr.  Denison.  How  would  this  bill  give  her  proper  nourishment  and  proper  care? 

Mr.  McGrady.  This  bill  would  enable  her  to  receive  the  proper  instructions. 

Mr.  Denison.  That  would  not  give  her  nourishment  and  care. 

Mr.  McGrady.  Undoubtedly,  as  far  as  nourishment  is  concerned,  if  she  received 
the  proper  education  at  the  proper  time,  from  these  nui'ses  who  would  go  out  and  visit 
these  women  during  that  trying  period,  doubtless  that  nurse  would  see  that  the  woman 
received  proper  nurishment  through  some  means. 

Mr.  Denison.  You  maan  then  that  this  bill  would  send  a  nurse  14  miles  over  the 
mountains  where  a  doctor  could  not  go? 

Mr.  McGrady.  No;  I  believe  that  this  bill  would  have  sent  the  proper  women, 
field  workers  or  nurses,  into  thos3  districts  before  this  crisis  arrived,  to  let  that  woman 
know  what  means  she  should  adopt  to  protect  herself;  how  she  should  cara  for  herself; 
and  if  the  woman  made  it  known  at  that  particular'  time  to  this  nurse  that  owing  to 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  59 

her  extreme  poverty  sha  could  not  follow  out  the  instructions  given  her,  undoubtedly 
means  would  be  obtained  to  see  that  she  was  projjerly  cared  for. 
■  Mr.  Denis(jn.  I  was  going  to  ask  you,  Mr.  McGrady,  is  it  your  understanding  now 
that  this  legislation  will  send  nurses  into  the  remote  and  secluded  and  mountainous 
districts  of  the  country  to  instruct  mothers  what  to  do? 

Mr.  McGkadv.  It  is  my  interpretation  of  this  bill  that  this  department  will  send 
proper  people  who  understand  this  particular  cjuestion  into  the  remote  districts  of  the 
country  to  instruct  the  people  how  they  might  care  for  themselves  during  this  period. 

Mr.  Denison.  Is  it  your  understandiag  then  that  the  Children's  Bureau  here  in 
Washington  is  goinjj'  to  send  nurses  out  into  Arizona  and  Colorado? 

Mr.  McC.trady.  ?sot  at  all. 

Mr.  Denison.  And  other  places,  remote  districts. 

Mr.  McGrady.  Not  at  all,  sir.  It  is  my  understanding  that  the  States  will  do  that 
work. 

Mr.  Denison.  That  the  States  will  do  it? 

Mr.  McGrady.  That  the  States  will  do  that  work,  providing  this  bill  passes. 

Mr.  Denison.  You  said  in  yoTir  testimony  before  ''this  department."  I  thought 
you  meant  the  department  here  in  Washington. 

Mr.  McGrauy.  I  meant  that  this  work  will  be  carried  on  by  the  States  if  this  bill 
passes.  We  have  no  idea  that  the  Federal  Government  is  going  to  interfere  with 
the  States  in  that  work. 

Mr.  Cooper.  Mr.  McGrady,  isn't  it  possible  that  under  this  bill,  through  the  as- 
sistance of  the  r^ederal  Government,  by  making  an  appropriation  the  States  would 
be  able  to  put  a  held  worker,  a  nurse,  into  these  remote  counties  where  it  is  hard  to 
get  a  physician  to-day? 

Mr.  McGrady.  That  is  just  the  point,  Mr.  Congressman,  that  I  am  trying  to  bring 
out. 

Mr.  Cooper.  And  in  a  maternity  case,  if  there  was  a  field  nurse  in  that  county, 
the  field  niu'se  would  know  about  this  particular  case;  and  it  seems  to  me  that  she 
would  be  the  one  that  would  give  the  help  at  the  proper  time  in  case  a  doctor  could 
not  be  gotten  just  when  he  was  needed. 

Mr.  McGrady.  That  is  just  the  point  that  I  am  trying  to  bring  out,  Mr.  Congress- 
man. 

Mr.  Denison.  In  that  connection,  don't  you  think  that  in  order  to  do  this  work 
better  than  the  doctors  can  now  do  it,  there  would  have  to  be  more  nurses  than  there 
would  be  doctors?  Certainly  nurses  can  not  get  around  and  over  the  country  faster 
than  the  physician  and  \dsit  more  people  than  the  doctors  that  are  there  already. 
Is  that  your  A'iew  of  it? '  That  is  the  way  I  understand  you. 

Mr.  McGrady.  I  don't  particularly  care  whether  it  is  a  doctor  or  a  nurse  that  goes 
over  to  do  this  work,  as  long  as  the  work  is  done  and  the  lives  of  these  200,000  children 
can  be  saved  yearly.  That  is  our  viewpoint.  We  are  crying  for  help  and  assistance 
for  these  people  who  can  not  help  themselves. 

Mr.  Denison.  I  am  siu-e  we  all  agree  with  that,  but  I  was  just  trying  to  get  at  your 
idea  of  the  method  of  doing  it. 

Mr.  Ha  WES.  The  economic  side  of  this  question,  of  course,  is  a  big  portion  of  it. 

Mr.  McGrady.  I  think  so. 

Mr.  Ha  WES.  Next  to  that  will  be  the  assistance  of  the  nurses. 

Mr.  McGrady\  Y'es,  sir. 

Mr.  Ha  WES.  I  was  attracted  to  you  illustration  of  the  disaster  in  the  mountains 
and  the  assistance  that  a  niu'se  could  give  in  such  a  case.  Now,  you  take  the  State 
of  Missouri,  we  have  114  counties  in  that  State.  Some  of  those  counties  are  10,  15, 
or  20  miles  square. 

Our  State  is  not  unlike  other  States.  If  we  had  two  nurses  in  each  one  of  thote 
counties,  that  would  make  228  nurses,  proA-iding  just  two  to  a  county  and  not  including 
the  cities.  If  we  paid  those  nurses  S5  a  day  it  would  cost  $1,100  or  81,200  a  day.  If 
we  multiplied  that  and  kept  those  two  nurses  in  each  county  busy  every  day  just  for 
two  nurses,  the  cost  would  approximate  something  like  §400,000.  Now  that  is  all 
right.  I  am  not  objecting  to  that,  but  under  this  bill  the  State  of  Missouri  would 
receive  only  §10,000  and  only  its  proportion  of  the  81,000,000,  say  830,000,  for  the 
simple  worlv  of  haA'ing  just  two  nurses  to  a  county,  which  would  not  be  of  any  im- 
portance at  all,  relatively.  So  when  we  get  down  to  the  basis  of  this  thing  this  bill 
is  educational  more  than  anything  else.     Isn't  that  your  opinion,  or  is  it  not? 

Mr.  McGrady'.  It  is  partly  educational. 

Mr.  Hawes.  As  a  matter  of  fact  it  is  educating  the  people  of  the  country  what  to 
do,  but  it  is  not  giving  them  practical  assistance  excepting  in  the  big  cities,  supple- 
mented by  voluntary  contributions.  I  want  to  get  your  theory  because  you  ought  to 
know. 


60  PUBLIC   PROTECTIOE"   OF   MATERlSriTY  AND   INFANCY. 

Mr.  McGrady.  It  is  an  educational  bill  and  it  teaches  hygiene.  I  feel  that  this  bill, 
if  it  passes  as  it  is  now,  while  the  conditions  may  be  such  as  you  sa> ,  while  it  may  be 
possible  that  it  is  going  to  mean  a  large  expenditure  of  money  to  do  the  work  properly ,- 
and  that  you  are  not  going  to  get  sufficient  mone >  right  away  to  do  that  work  properly ; 
nevertheless,  you  are  going  to  get  enough  extra  money  to  save  a  great  many  lives  that 
otherwise  would  be  lost,  even  though  the  work  might  be  inadequate  at  this  time  it 
starts  a  foundation  that  is  going  to  save  lives,  and  that  is  worth  striving  for. 

Mr.  Hawes.  There  was  a  \^ery  intelligent  lady  connected  with  the  health  depart- 
ment of  Pennsylvania  who  spoke  yesterday  advocating  this  bill.  She  stated  that  the 
cost  to  the  State  of  Pennsylvania  for  the  board  of  health  was  something  like  five  or  six 
million  dollars.  Under  this  bill  the  State  of  Pennsylvania,  as  I  understand  it,  would 
receive  approximately  140,000  from  the  National  Governmert,  and  according  to  Mr. 
Towner  the  National  Government  would  have  no  control  over  the  State  at  all  in  any 
way.  It  is  just  a  nice  little  contribution  of  $40,000  to  encourage  that  work.  Eoes 
that  sound  like  a  practical  proposition  to  you? 

.  Mr.  McGrady.  It  sounds  practical  to  this  extent:  The  State  of  Pennsylvania  is 
going  to  get  §40, .000  more  than  it  had  before,  and  that  $40,000  more  than  it  had  before 
means  that  more  babies  and  mothers  are  going  to  be  saved.  To  that  extent,  in  my 
opinion,  it  is  practical. 

Mr.  Hawes.  It  goes  a  little  further  than  that,  because  it  makes  the  State  of  Penn- 
sylvania put  up  ifs  $40,000,  which  means  $80,000. 

Mr.  McGrady.  I  am  sure  it  is  needed,  and  more  than  $80,000  is  needed  properly 
in  that  big  State. 

Mr.  Hawes.  I  am  asking  this  question  of  the  witness,  as  the  witness  understands, 
because  I  want  to  find  out  whether  this  bill  is  to  provide  nurses,  and  doctors,  and  food, 
or  whether  it  is  purely  educational.  The  only  way  to  find  out  is  by  asking  a  practical 
man  like  yourself. 

Mr.  McGrady.  Thank  you  very  much,  but  I  want  to  assure  you  that  I  would  much 
prefer  to  have  Judge  Towner  answer  that,  as  he  has  promised  he  would  do  later  on. 

Mr.  Barkley.  You  have  emphasized  the  economic  side  of  this  situation.  Most 
people  think  of  economics  in  terms  of  money.  1  don't  a.gree  with  that  interpretation 
of  this  bill.  Is  it  not  true  that  the  social  side  is  as  important  as  the  economic  side? 
In  other  words,  hasn't  every  child  that  is  born  in  the  world  the  right  to  an  even  chance 
to  live,  and  every  mother  that  bears  that  child  the  right  to  an  even  chance  to  live,  and 
isn't  that  as  much  social  as  it  is  economic? 

Mr.  McGrady.  I  do  not  believe  that  every  child  has  got  an  equal  chance  to  live  that 
comes  into  the  world. 

Mr.  Barkley.  Ought  it  not  to  have? 

Mr.  McGrady.  It  ought  to  have,  yes,  Congi-essman,  and  the  economic  side  comes 
into  it  there.  When  a  man  is  getting  $500  or  $600  a  year  and  he  has  got  two  or  three 
children,  his  children  are  always  half  fed  and  his  wife  not  even  that  much.  She  can't 
stand  the  strain. 

Mr.  Barkley.  Of  course  it  is  difficult  to  separate  economics  and  sociology  so  that 
each  occupies  a  separate  field.  They  lap  and  dovetail  into  each  other  everywhere. 
It  strikes  me  that  while-  the  economic  side  is  important  that  it  is  not  the  paramount 
question  here  at  all. 

Mr.  McGrady.  Well,  I  am  going  to  be  perfectly  frank  with  you,  CbngTessman.  We 
believe  that  if  the  workingmen  of  the  country  received  an  adequate  wage  scale  that 
most  of  oiu  physical  ills  would  be  well  taken  care  of. 

Mr.  Barkley.  Well,  is  it  not  true  that  there  is  vast  ignorance  among  people  who 
are  pretty  well  to  do  and  draw  pretty  good  pay  on  the  subject  of  maternity  and  child 
hygiene? 

Mr.  McGrady.  Well,  that  ignorance,  if  it  exists,  should  not;  because  they  have  got 
the  means  of  enlighlenoaent,  whereas  our  people  have  not. 

Mr.  Barkley.  They  may  not  have.  They  may  live  in  a  section  of  the  country 
where  their  means  of  obtaining  information  may  be  very  limited. 

Mr.  McGrady.  If  they  have  got  the  price,  they  can  get  the  information. 

Mr.  Barkley.  Of  course  if  they  had  the  price  they  could  all  hire  a  special  nurse  by 
the  year.  They  might  get  it  by  a  correspondence  course.  But  nobody  would  recom- 
mend that.     I  think  these  facilities  ought  to  be  available  for  all  who  need  them. 

Mr.  McGrady.  That  would  be  a  poor  way  to  learn  anything  about  a  matter  dealing 
with  life  or  death. 

Mr.  Lea.  I  believe  you  are  the  legislative  representative. of  the  Federation  of  Labor? 

Mr.  McGrady.  One  of  them. 

Mr.  Lea.  Are  you  familiar  with  what  is  being  done  or  what  has  been  done  to  secure 
independent  action  by  the  various  States  in  these  matters? 


PUBLIC   PKOTECTTON   OF   MATERNITY  AND  INFANCY.  61 

Mr.  Mc(iUAiiY.  We  have  had  our  altcntion  called  to  it,  and  up  to  tho  present  time 
we  don't  see  where  the  States  are  endan,<i;tn'(id  in  any  way  at  all  by  this  particulai-  Vjill. 

Mr.  Lk.v.  No;  that  was  not  the  object  of  my  question.  I  wanted  to  understand  how 
the  State  legislatures  are  receiving  these  suggestions,  and  what  have  the  States  done 
to  meet  the  situation? 

Mr.  McCtkadv.  I  am  Tiot  familiar  with  that,  because  I  haven't  got  the  State  reports 
on  legislation  of  this  kind. 

Mr.  Lea.  You  are  not  the  representative  so  far  as  State  legislatures  are  concerned? 

Mr.  McGhapy.  No. 

Mr.  Ghaham.  Has  votu"  federation  taken  action  on  the  so-called  Smith-Towner 
bill? 

Mr.  McGijADY.  Yes,  sir. 

Mr.  Git.vMAM.  Ihu-e  you  indorsed  that  bill? 

Mr.  Mc'GuADY.  Yes,  sir.  • 

Afr.  Graham.  Have  you  taken  action  on  the  so-called  Fess-Capper  physical  edu- 
cation bill? 

Mr.  McGrady.  That  I  do  not  know. 

Mr.  Graham.  You  don't  know  whether  your  people  are  for  that  or  not,  but  you 
are  for  the  Smith-Towner  bill? 

Mr.  JiIcGiJAnY.  Yes,  sir. 

Mr.  Graham.  Because  you  think  that  the  Government  ought  also  to  appropriate 
money  along  educational  lines? 

Mr.  McGrady.  Yes.  sir. 

Mr.  Graham.  That  is  all.  . 

The  Chairman.  Are  there  any  other  questions?  Thank  you  very  much,  Mr. 
McGrady. 

Now.  gentlemen  of  the  committee,  we  are  within  three  minutes  of  the  time  when 
the  opportunity  accorded  by  the  committee  for  the  proponents  of  this  bill  to  present 
their  case  will  have  expired.  We  have  to  consider  the  question  as  to  their  desires, 
I  presume,  for  further  time.  While  that  is  one  of  the  matters  to  be  considered,  we 
also  haA-e  to  consider  whether  or  n,ot  we  will  sit  to-morrow,  and  if  so,  at  what  hour; 
if  not,  when  will  we  sit  again?  Now  what  is  the  pleasxire  of  the  committee  in  respect 
to  the  several  propositions? 

Mr.  Sweet.  I  would  like  to  ask  Judge  Towner  a  question,  and  that  is  how  long 
will  it  take  you,  with  the  witnesses  that  yoii  have  here,  to  fully  present  your  side  of 
the  case? 

Mr.  Towner.  Well,  we  are  trying  to  act  upon  the  suggestions  of  the  committee 
with  regard  to  that  matter.  We  are  willing  to  submit  it  now.  We  have  two  or  three 
other  witnesses  tliat  woald  occupy  only  a  short  time — we  would  have  iinished  our 
case  if  it  had  not  been — if  the  time  had  not  been  taken  up  by  our  constitutional 
propositions. 

Mr.  Graham.  Now,  Judge,  do  you  not  think  that  it  is  entirely  proper  for  a  member 
of  this  committee  to  suggest  to  witnesses  their  ideas  about  these  things  also  as  we 
go  along? 

Mr.  Towner.  I  have  no  objections,  whatever.  I  am  just  ex])laining  the  manner 
in  which  the  time  has  been  used.  We  will  close  our  case  now,  or  we  will  occupy 
the  time  for  perhaps  half  an  hour  or  more  some  other  time;  just  as  the  committee 
desires. 

Mr.  Huddleston.  Mr.  Chairman,  may  I  suggest  that  the  proponents  have  the 
balance  of  the  morning  at  this  session;  then  we  will  take  up  to-morrow  the  hearing 
of  the  opposition.     How  mil  that  suit  you,  Mr.  Towner? 

Mr.  Towner.  I  think  we  could  finish  in  less  than  that  time,  Mr.  Chairman,  unless 
the  examination  is  continued. 

The  Chairman.  Well,  the  chairman  will  not  be  responsible  for  the  inquiries  of  the 
committee. 

Mr.  Rayburn.  About  those  inquiries  on  the  part  of  the  committee,  the  committee 
wants  information.  It  is  not  interested  in  whether  or  not  the  witnesses  make  speeches, 
and  by  asking  questions  is  the  way  that  we  can  remove  the  clouds  from  our  minds 
by  interrogating  people  who  are  supposed  to  understand  this  question.  A  great  many 
times  a  set  speech  is  beautiful,  but  sometimes  it  doesn't  penetrate  the  veil.of  ignorance 
of  the  member  of  the  committee,  and  he  has  to  ask  a  question  in  order  to  understand 
what  the  speech  means,  and  that  is  the  reason  why  this  committee  is  inquisitive.  I 
think  the  proponents  of  the  bill,  Judge  Towner,  should  have  the  remainder  of  this 
morning  or  as  much  time  as  they  desire. 

Mr.  Cooper.  Mr.  Chairman,  I  make  a  motion,  in  order  to  bring  this  to  a  head,  that 
the  proponents  of  the  bill  be  given  the  balance  of  this  morning.  To-morrow  morning 
we  meet  at  9.30  and  listen  to  the  opponents. 


62  PUBLIC   PROTECTIOlSr   or   MATERNITY   AND   INFANCY. 

The  Chairman.  Mr.  Huddleston  made  a  motion.    Will  you  state  that? 

Mr.  Huddleston.  I  will  withdraw  mine  in  favor  of  Mr.  Cooper's  motion. 

The  Chairman.  The  motion  is  made  that  we  hear  the  proponents  of  the  bill  until 
11  o'clock  this  morning,  and  that  beginning  at  9.30  to-morrow  morning  those  who 
wish  to  speak  in  opposition  to  the  bill  will  begin  to  be  heard. 

(The  motion  was  put  and  carried.) 

The  Chairman.  The  motion  is  carried.    You  may  proceed,  Judge  Towner. 

Mr.  Towner.  Mr.  Chairman,  I  will  call  Dr.  John  H.  Foote  to  the  stand.  Dr.  Foote 
is  a  professor  in  Georgetown  University,  editor  of  Mother  and  Child,  and  is  on  the 
staff  of  the  Children's  Hospital  in  Washington. 

STATEMENT  OF  DR.  JOHN  A.  FOOTE,  WASHINGTON,  D.  C. 

Dr.  Foote.  Mr.  Chairman  and  gentlemen  of  the  committee,  you  have  heard  ai'gu- 
ments  for  this  bill  from  experts  in  public-health  matters,  from  physicians,  such  as 
Dr.  Van  Ingen,  especially  interested  in  vital  statistics  as  well  as  in  the  i)ractice  of 
medicine,  and  from  experts  in  sociology  and  economics,  etc.  I  am  coming  before 
you  simply  as  a  physician.  I  am  not  qualifying  or  trying  to  qualify  as  an  expert  in 
anything;  I  am  simply  trying  to  give  you — I  am  going  to  try  to  give  you — what  I 
think  of  this  bill  as  a  physician  who  is  practicing  medicine  and  is  particularly  inter- 
ested in  the  diseases  and  the  health  of  children;  and  I  am  making  this  announcement 
so  that  you  may  not  misunderstand  my  position  in  testifying  here  to-day. 

I  am  interested  in  statistics  to  the  extent  that  statistics  apply  to  the  day's  work 
and  to  my  interest  in  child  welfare  generally,  and  I  believe  that  the  interpretation 
and  understanding  of  statistics  is  a  gift  or  a  talent,  perhaps  a  particular  talent,  such 
as  a  gift  for  music  or  a  talent  for  politics,  or  whatever  it  may  be.  So  I  have  just  the 
ordinary  understanding  of  these  matters  that  would  come  to  a  person  who  reads  things 
from  day  to  day  and  confers  with  individuals  who  have  an  extraordinary  knowledge 
of  them. 

Vital  statistics  to  the  man  in  the  street  or  the  woman  in  the  home  are  not  really  vital 
until  some  member  of  the  family  becomes  a  part  of  the  statistics;  then  they  do  become 
really  vital,  and  it  has  occurred  to  me  as  I  sat  here  and  noticed  the  interest  that  you 
gentlemen  have  in  the  statistics  that  are  brought  forth  in  the  testimony,  that  the  same 
thought  had  perhaps  come  home  to  you — the  thought  that  in  the  United  States  every 
year  from  18,000  to  perhaps  23,000  mothers  have  died,  and  that  in  these  homes  have 
come  a  tragedy,  and  that  this  tragedy  might  have  been  prevented  by  some  measures 
that  could  have  been  taken  but  which  were  not  taken.  That  thought,  of  course,  does 
humanize  and  vitalize  these  statistics;  it  brings  them  home  to  all  of  us  because  it 
shows  us  their  personal  application.  As  I  said,  statistics  are  only  relative  things — 
"relativity"  is  a  word  that  we  are  using  a  lot  now — ^but  it  is  true  that  vital  statistics 
have  only  relativity  until  they  become  specific  to  the  individual. 

You  have  heard  numerous  witnesses  here  proving  the  need_  of  this  legislation  from 
various  angles.  The  testimony  of  health  experts,  of  statisticians,  and  the  testimony 
of  physicians  has  been  quoted— men  like  Dr.  Van  Ingen  and  men  like  Dr.^Wall,  who, 
I  think,  appeared  before  the  Senate  committee.  In  an  investigation  of  this  kind  you 
may  get  ideas  from  various  groups  of  people;  but  the  large  majority  of  people  most 
interested  have  no  official  representative  here.  The  people  really  most  interested  are 
those  who,  perhaps,  do  not  even^know  that  this  kind  of  legislation  is  pending,  who 
have  no  organized  representation  here,  excepting  as  the  members  of  this  committee 
are  in  fact  the  representatives  of  those  people  and  of  all  the  people  of  the  United  States. 

I  do  not  think  that  in  the  history  of  laws  of  this  sort,  or  legislation  of  this  sort,  the 
people  who  are  most  benefited  have  ever  organized  and  asked  for  the  needed  legis- 
lation. Hammurabi,  the  great  king  of  Babylon,  who  lived  over  6,000  years  ago,  I 
think  enacted  the  first  law  to  benefit  maternity.  The  code  of  Hammurabi  contained 
a  law  protecting  the  pregnant  woman,  specifying  that  the  pregnant  woman  who  was 
injured  should  have  redress — that  the  person  who  injured  a  pregnant  woman  will- 
fully should  be  punished.  He  was  a  really  great  king.  He  did  not  have  to  make  any 
laws  to  benefit  anybody,  but  he  did  so  because  he  thought  that  to  confer  rights  and 
benefits  on  his  helpless  people  was  a  just  thing  to  do. 

There  are  two  classes  of  physicians,  I  think,  who  are  especially  interested  in  the 
kind  of  legislation  that  is  embodied  in  this  bill.  They  are  the  physicians  in  the  large 
cities  who  wander  through  the  hospitals  doing  their  day's  work,  who  see  the  wreckage, 
you  might  say,  that  comes  from  the  storm  of  life;  and  they  are  the  physicians,  many 
of  the  physicians,  in  the  rural  districts,  who  have  been  trained  in  scientific  medicine 
and  who  find  themselves  in  the  rural  districts  more  or  less  helpless  because  of  lack  of 
assistance. 

I  would  like  to  read  something  which  \^dll  perhaps  give  an  idea  of  the  point  of  view 
of  some  of  the  country  doctors.     The  country  doctor,  as  I  said  before,  leaves  th© 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  63 

scientifically  arranged  hospital,  leaves  the  city,  and  goes  to  the  country  and  leaves 
behind  him,  in  the  suburbs  and  the  districts  near  to  the  city,  the  outposts  of  scientific 
health  education  and  the  outposts  of  sanitation.  I  hope  that  that  will  not  be  so 
always,  but  I  think  that  no  one  can  very  well  dispute  that  such  is  the  fact  to-day; 
and  I  would  like,  if  I  may,  to  read  to  you  some  extracts  that  are  not  long,  from  an 
article  entitled  "Expectant  mothers  in  rural  regions,"  written  by  Lottie  G.  Bigler, 
M.  I).,  general  practitioner  in  the  town  of  Armour,  S.  Dak.  This  article  was  published 
in  the  magazine  Mother  and  Child,  volume  2,  No.  2,  in  February,  1921.  Dr.  Bigler 
said  in  part: 

■According  to  statistics  taken -from  the  rural  communities  of  six  different  States, 
80  per  cent  of  the  pregnant  women  have  received  no  advice  or  instruction  during 
pregnancy.  This  percentage  is  even  higher  in  some  localities.  At  least  half  of  the 
women  do  not  engage  a  doctor  before  the  last  month.  Many  of  those  who  do  so  com- 
municate with  the  doctor  either  over  the  telephone  or  by  letter.  I  do  not  think  that 
the  laity  are  entirely  to  blame,  for  many  women  have  told  me  that  when  they  had 
asked  their  doctors  if  a  urinal3rsis  ought  not  to  be  made,  the  doctor  said  it  wasn't 
necessary.  We  general  practitioners  need  to  be  stirred  irp,  for  I  believe  we  are  all 
lax  in  tliis  matter.  If  we  would  seize  every  opportunity,  a  great  deal  might  be  done 
toward  educating  our  patients. 

"care  given  pedigreed  stock. 

"Isolated  families,  some  of  which  are  70  miles  from  a  doctor,  are  the  ones  who  pre- 
sent the  greatest  problems.  Many  of  them  depend  on  ignorant  midwives  for  their 
care  and  instruction.  Many  women  die  before  a  doctor  can  get  to  them.  Many  of 
these  farmers  are  foreigners.  They  need  help  badly  and  are  the  hardest  to  reach,  for 
they  look  with  suspicion  on  any  innovations.  The  mothers  often  work  in  the  fields 
up  to  the  last  minute,  performing  most  arduous  tasks.  It  seems  to  me  that  the  ex- 
pectant mother  in  the  barnyard  gets  far  more  attention  and  better  care  then  the  one 
in  the  house.  If  the  barnyard  mother  gets  sick,  the  whole  household  is  upset, 
especially  if  she  be  a  pedigreed  animal.  The  farmer  sends  for  the  best  veterinarian, 
possilily  miles  away.  The  State  provides  free  courses  of  instruction  as  to  how  to  keep 
the  animals  healthy  and  how  to  produce  the  strongest  offspring. 

"solving  the  rural  problem. 

'No  doubt  these  problems  of  expectant  mothers  in  rural  communities  have  to  be 
approached  in  different  w£»ys  in  different  communities.  The  crying  need  is  for 
nurses  trained  for  rural  work.  The  average  nurse,  born  and  raised  in  the  city,  is  un- 
able to  adapt  herself  to  rural  conditions.  One  nurse  for  a  county  is  insufficient. 
There  should  be  enough  nurses  so  that  all  homes  could  be  visited  and  individual 
instruction  given.  Health  centers  and  free  clinics  should  be  organized  with  the  school- 
house  as  a  meeting  place.  Sterile  supplies  should  be  provided  at  cost.  The  school 
teacher  could  give  some  instruction  if  she  were  capable.  We  must  have  better  pub- 
lic health  inspection  in  the  rural  homes.  Here,  often  by  chance,  we  discover  con- 
tagious diseases  raging  with  no  effort  made  at  isolation  of  the  sick,  and  in  most  cases 
it  is  not  even  reported.  By  special  legislation  we  might  accomplish  much.  The 
Sheppard-Towner  bill  may  help  solve  these  problems  effectively.  At  least,  it  would 
do  much  to  protect  the  prospective  mother  and  her  infant.  We  must  face  these  prob- 
lems squarely  and  do  all  in  our  power  to  give  the  expectant  mother  and  the  unborn 
infant  the  best  possible  chance." 

^Ir.  IIawes.  Doctor,  do  you  think  that  that  statement  that  80  per  cent  of  the  women 
had  not  consulted  a  physician  is  correct? 

Dr.  FooTE.  I  have  the  impression  that  it  is.  As  I  said,  I  could  not  qualify  specifi- 
cally as  a  statistician,  but  I  believe  that  those  figiu'es  are  based  on  a  survey  made  by 
the  Children's  Bureau  in  rural  districts. 

Mr.  Hawes.  Do  you  mean  that  they  consulted  nobody  or  had  not  consulted  doctors? 

Dr.  FooTE.  I  take  it  that  they  had  no  medical  advice. 

Mr.  Hawes.  No  medical  advice?  Well,  then,  is  it  your  opinion  that  they  all 
required  medical  advice? 

Dr.  Foote.  IMay  I  look  at 

Mr.  IL\WEs  (interposing).  ]\fay  I  ask  you  to  answer  the  question? 

Dr.  Foote.  I  beg  pardon — is  it. my  opinion  that  they  all  required  medical  advice? 
ertainly. 

Mr.  Hawes.  You  think  they  do? 

Dr.  Foote.  Yes,  sir. 

Mr.  Hawes.  Then  in  the  matter  of  childbirth,  when  we  divide  this  into  three 
^la^ses,  economic,  social,  and  medical,  what  proportion  do  you  place  in  priority? 


64  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Dr.  FooTE.  I  don't  think  that  I  am  qualified  to  answer  that  question,  because 
I  have  not  the  statistical  knowledge. 

Mr.  Hawes.  You  are  discussing  this  whole  subject  and  you  are  a  doctor. 

Dr.  FooTE.  Yes. 

Mr.  Hawes.  You  have  an  opinion  on  it? 

Dr.  FooTE.  Well,  I  do  not  think  I  could  give  an  opinion  as  to  the  relative  per- 
centages. I  believe  that  the  division  that  you  spoke  of  is  correct — all  three  elements 
enter  into  this  subject — but  as  to  relative  percentages,  I  do  not  think  I  am  prepared, 
indeed,  I  do  not  think  I  am  competent  to  tell  you. 

Mr.  Hawes.  You  do  not  think  you  are  competent  to  express  an  opinion  as  to  the 
relative  value? 

Dr.  FooTE.  I  think  they  are  all  valuable. 

Mr.  Hawes.  But  you  do  believe  that  in  all  cases  of  confinement  a  physician  should 
be  consulted? 

Dr.  FooTE.  I  think  that  in  all  cases  of  confinement  a  physician,  when  possible, 
should  be  consulted. 

Mr.  Hawes.  But  you  are  not  prepared  to  give  us  the  benefit  of  your  advice  as  to 
these  different  proportions? 

Dr.  FooTE.  As  to  the  different  proportions? 

Mr.  Hawes.  We  have  heard  this  discussed,  doctor,-  and  it  is  important  for  this 
committee  to  come  to  some  decision.  We  want  to  know  whether  this  is  an  educational 
bill,  advising  mothers.  That  is  one  portion.  Whether  it  is  because  they  are  not 
sufficiently  provided  with  proper  food  and  shelter  and  raiment,  or  whether  it  is  the 
lack  of  medical  attention.  Now,  what  is  your  impression  of  the  relative  value  of  those 
three  things?     Would  it  be  3.3J  per  cent  each,  or  would  it  be  of  different  proportions? 

Dr.  FooTE.  Mr.  Hawes,  I  can  not  give  any  definite  impression  about  that,  because 
conditions  vary  in  every  community  in  the  United  States. 

Mr.  Hawes.  The  conditions  vary? 

Dr.  Foots.  I  mean  the  social  conditions. 

Mr.  Hawes.  Where  do  you  live,  doctor? 

Dr.  FooTE.  I  live  here  in  Washington. 

Mr.  Hawes.  What  is  your  impression  about  it  here? 

Dr.  FooTE.  My  general  impression  is  that  lack  of  medical  and  nursing  care  would 
probably  be  the  greatest  factor  in  Washington. 

Mr.  Hawes.  Would  that  be  50  per  cent? 

Dr.  FooTE.  I  don't  think  I  am  competent  to  answer  that  question,  because  I  have 
not  made  a  study  of  statistics. 

Mr.  Hawes.  You  do  not  feel  qualified  to  answer  that? 

Dr.  Foote.  I  do  not  feel  qualified  to  answer  that  question. 

Mr.  Hawes.  But  you  have  a  very  firm  conviction  on  the  whole  subject  of  this  bill? 

Dr.  Foote.  I  have  a  firm  conviction  as  to  the  necessity  of  education  and  of  nursing 
care  when  possible,  and  of  medical  attention  when  possible,  and  I  believe  that  this 
bill  will  help  along  those  lines,  according  to  the  different  programs  of  the  different 
States  to  meet  the  peculiar  conditions  of  these  States  and  counties  and  communities. 

Mr.  Hawes.  I  am  trying  to  find  out,  doctor,  whether  we  need  more  doctors,  more 
food  or  more  education.  Now  I  want  an  opinion.  If  you  say  you  can  not  answer  it, 
it  is  all  right,  but  which  do  you  think  will  require  the  most  in  these  cas^s? 

Dr.  Foote.  I  think  that  we  require  both  doctors  and  nurses  and  education  in  the 
rural  districts. 

Mr.  Hawes.  We  will  admit  that,  but  which  has  the  priority,  in  your  mind?  Which 
need  is  the  greatest?    Have  you  an  opinion  on  that? 

Dr.  Foote.  I  would  say  that  in  my  opinion — I  do  not  think  my  opinion  is  worth 
very  much — but  if  you  would  like  to  have  it,  I  would  say  that  in  the  rural  districts 
generally  the  need  perhaps  of  health  education  was  the  more  important. 

Mr.  Hawes.  More  important  then  the  actual  administration  of  a  doctor? 
_  Dr.  Foote.  No.     I  would  like  also  to  say  that  there  is  a  very  great  shortage  of  phy- 
sicians in  the  rural  districts  to-day,  and  that  this  need  of  physicians  in  the  rural 
districts  is  also  a  very  acute  condition  in  some  sections  of  this  country. 

Mr.  Hawes.  You  practice  in  Washington  yourself? 

Dr.  Foote.  I  practice  in  Washington. 

Mr.  Cooper.  May  I  ask  the  doctor  a  question,  Mr.  Chairman? 

The  Chairman.  Have  you  finished,  Mr.  Hawes? 

Mr.  Hawes.  Yes,  sir. 

Mr.  Cooper.  Doctor,  can  you  consider  the  medical,  the  educational  features  of  this 
proposition  without  taking  in  the  social  and  the  economic  conditions? 

Dr.  Foote.  I  think  it  would  be  very  diflficult.  I  think  they  are  closely  bound 
together.  I  might  illustrate  that  by  saying  that  a  rural  physician  who  is  attending  an 
expectant  mother  might  want  to  give  her  advice,  but  because  of  the  acute  needs  of 


PUBLIC  PROTECTION   OF   MATERNITY   AND  INFANCY.  65 

some  other  person  in  the  comniunily  might  not  be  able  to  get  over  a  certain  distance 
to  give  this  mother  such  medical  advice.  He  might  not,  for  instance,  be  able  to 
get  a  sample  of  urine  to  be  examined  when  he  thought  it  might  be  necessary.  In  other 
words,  because  of  a  rush  of  work,  practically  obliging  him  to  attend  to  acute  cases, 
he  might  be  obliged  to  neglect  educational  features  that  are  important. 

Mr.  Cooper.  In  other  words,  doctor,  supposing  the  physician  would  advise  the 
mother  that  she  should  receive  some  instruction  from  a  nurse,  and  the  mother  by  reason 
of  social  or  economic  conditions  did  not  have  the  money  to  secure  that  nurse,  the  advice 
of  the  physician  would  not  be  worth  anything,  would  it,  if  the  mother  could  not  follow 
out  the  instructions  of  the  physician? 

Dr.  FooTE.  Well,  I  think  the  advice  or  the  instruction  of  the  phy.4cian  would,  of 
course,  have  great  value 

Mr.  Cooper.  If  it  could  be  carried  out. 

Dr.  FooTE.  If  it  could  be  carried  out,  and  it  would  have  some  value — at  least  some 
part  of  it  could  be  carried  out  without  the  cooperation  of  the  nurse.  It  would  have  a 
certain  value  in  any  case,  but  it  would  have  more  value  and  much  greater  value  if 
that  woman  could  have  the  ministrations  of  a  nurse  to  check  up  her  condition. 

Mr.  Cooper.  I  vrill  put  it  that  way,  then,  that  it  would  have  much  greater  value. 

Dr.  P^ooTE.  Yes;  it  would. 

Mr.  Rayburn.  Doctor,  you  do  not  have  any  statistics,  or  do  not  know  the  statictics, 
but  I  would  like  to  have  your  opinion  as  to  what  is  the  mortality,  the  percentage  of 
mortality  among  mothers  of  infants,  as  to  whether  it  is  greater  in  the  rural  districts 
than  it  is  in  the  cities? 

Dr.  FooTE.  That  I  do  not  think  I  am  competent  to  answer;  but  it  is  my  impression 
that  it  is  higher  in  the  rural  districts. 

Mr.  Rayburn.  How  did  you  get  that  impression? 

Dr.  FooTE.  By  looking  over  general  tables  of  vital  statistics,  and  by  reading  articles 
"written  by  individuals  who  have  made  some  studies  in  that  regard.  I  think  Dr. 
Lumsden  of  the  Public  Health  Service  made  some  valuable  studies  of  rural  health 
conditions.  I  have  read  articles  in  various  magazines;  though,  of  course,  in  making  a 
statement  regarding  statistics  one  should  have  the  article  at  hand  in  order  to  be  able 
to  state  definitely. 

Mr.  Rayburn.  I  am  not  talking  about  the  number;  I  am  talking  about  the  per- 
centage. 

Dr.  FooTE.  The  percentage — do  you  mean  infant  mortality  or  maternal  mortality? 

Mr.  Rayburn.  I  mean  both,  the  mortality  at  childbirth  in  the  rural  districts  and  in 
the  cities  or  towns,  the  percentage,  not  the  number. 

Dr.  FooTE.  Mr.  Rayburn,  I  am  not  prepared  to  answer  that  question. 

Mr.  Rayburn.  I  •would  like  to  ask  if  Judge  Towner,  or  some  witness  he  has  before 
the  hearings  close,  will  try  to  get  those  statistics. 

Mr.  Towner.  We  will  try  to  get  them. 

Mr.  HuDDLESTON.  Dr.  Foote,  I  believe  the  committee  would  be  interested  to 
know  what  is  being  done  here  in  the  District  of  Columbia  in  the  way  of  maternal 
care  and  infant  health  work. 

Dr.  Foote.  There  is  a  Child  Welfare  Association  in  the  District  of  Columbia  that 
is  supported  partly — and  was  supported  entirely — by  private  contributions  until, 
I  think,  two  years  ago,  and  I  think  since  that  time  it  has  had  an  appropriation  from 
Congress  to  the  extent  of  $18,000.  The  association  maintains  10  infant-welfare 
stations  where  instruction  is  given  in  child  welfare,  the  proper  care  of  the  infant, 
and  in  prenatal  care,  which  means  proper  instruction  of  the  mother. 

Mr.  Towner.  Mr.  Chairman,  it  is  now  just  a  very  few  minutes  of  11  o'clock.  May 
I  ask  permission  that  Dr.  Foote  may  finish  his  statement  in  the  record,  for  publication? 

The  Chairman.  Has  the  committee  any  objection  to  the  request  of  Judge  Towner? 
Is  it  your  desire  to  withdraw  the  \\itness? 

Dr'  Foote.  I  simply  want  to  say  in  conclusion  that  I  have  appeared  before  this 
committee  because  as  a  physician  I  believe  that  the  Sheppard- Towner  bill  is  the  best 
possible  measure  to  do  the  particular  work  that  it  is  suggested  it  should  do,  that  I  am 
familiar  with. 

The  Chairman.  You  will  have  the  privilege  to  extend  your  remarks  to  a  reasonable 
extent  and  hand  them  in  to  the  clerk  of  the  committee  and  they  will  he  published 
in  the  record. 

Dr.  Foote.  I  have  nothing  further  to  say,  Mr.  Chairman. 

The  Chairman.  We  are  very -much  obliged  to  you,  Doctor, 

Mr.  Towner.  Mr.  Chairman,  at  this  time  I  woiild  like  to  offer  for  the  record  a  state- 
ment on  behalf  of  the  women's  committee,  composed  of  a  number  of  associations, 
■which  is  short  in  its  nature  and  explains  the  attitude  of  these  organizations. 

The  Chairman.  It  may  be  placed  in  the  record. 

(The  papers  referred  to  follow:) 

74654—21 .5 


66  PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY. 

STATEMENT    ON    BEHALF    OP    THE    WOMEN's    COMMITTEE    ON    THE    SHEPPARD-TOWNER 

BILL. 

The  national  women's  organizations  which  have  indorsed  the  Sheppard- Towner 
bill  have  formed  a  joint  committee — the  women's  committee  on  the  Sheppard- Towner 
bill — which  has  for  many  months  been  cooperating  in  the  work  for  the  passage  of  this 
measure.  This  committee  consists  of  representatives  of  the  following  organizations: 
American  Association  of  University  Women,  American  Home  Economics  Association, 
General  Federation  of  Women's  Clubs,  Girls'  Friendly  Society  in  America,  National 
Board  of  the  Young  Women's  Christian  Association,  National  Congress  of  Mothers 
and  Parent-Teacher  Associations,  National  Consumers'  League,  National  Federation 
of  Business  and  Professional  Women,  National  League  of  Women  Voters,  National 
Society,  Daughters  of  the  American  Revolution,  National  Woman's  Christian  Tem- 
perance Union, National  Women's  Trade  Union  League,  the  Council  of  Jewish  Women. 

It  was  the  intention  of  representatives  of  this  committee  to  appear  in  pereon  before 
the  House  Committee  on  Interstate  and  Foreign  Commerce  at  the  hearings  now  being 
conducted  to  present  the  indorsements  of  their  organizations.  In  xiew,  however, 
of  the  length  of  time  already  allotted  to  the  discussion  of  this  bill  and  our  desire  not 
to  delay  the  hearings,  it  has  been  decided  that  the  organizations  will  not  ask  to  be 
heard  indi\ddually,  but  will  file  statements  with  the  committee  if  permitted  so  to  do. 

It  may  conservatively  be  said  that  the  membership  of  our  combined  organizations 
run  into  the  millions.  It  is  also  true  that  to  them  the  Sheppard-Towner  bill  is  of  the 
very  foremost  importance,  and  that  no  other  measure  has  had  so  much  publicity  or 
been  the  subject  of  such  widespread  interest  among  our  members.  We  believe  that 
it  is  a  life-sa%'ing  measure,  and  that  as  such  it  should  be  passed;  we  believe  that  it  is 
a  much  needed  educational  measure,  and  that  as  such  it  deserves  support.  We  believe 
that  the  contention  that  it  will  cause  undue  centralization  is  unfounded,  because  it 
provides  only  for  Federal  aid  to  permit  the  States  to  do  their  own  work  through  their 
own  already  existing  agencies.  We  believe  in  the  administrative  features  of  the  bill 
as  they  now  stand,  because  we  know  that  the  Children's  Bureau  is  the  pioneer  child 
hygiene  service  of  the  Federal  Government;  that  it  was  created  in  part  to  do  child 
hygiene  work  which  no  other  Government  bureau  was  doing,  and  that  it  has  done  this 
work  with  marked  success,  and  also  because  we  believe  that  the  educational  and 
social  features  of  infant  and  maternal  welfare  work  should  be  considered  in  the  plans 
of  the  States,  as  well  as  the  purely  medical  ones.  We  hope  that  as  this  bill  was  unani- 
mously reported  by  the  House  Committee  on  Interstate  Commerce,  after  exhaustive 
hearing,  in  the  Sixty -sixth  Congress,  it  will  again  report  it  promptly  for  the  considera- 
tion of  the  Sixty-seventh  Congress. 

Lenna  Lowe  Yost, 

Chairman  Woman's  Committee. 
Dorothy  Kirchwey-  Brown,  f 

Secretary  Woman's  Committee. 

The  American  Home  Economics  Association  heartily  indorses  the  Sheppard-Towner 
bill  (S.  1039,  H.  R.  2366)  providing  for  the  public  protection  of  maternity  and  infancy 
and  urges  its  speedy  enactment  into  law. 

The  object  of  the  American  Home  Economics  Association  is  to  improve  the  condi- 
tions of  li^dng  in  the  home,  institutional  household,  and  the  community.  The  asso- 
ciation is  primarily  interested  in  the  betterment  of  the  home  life  of  the  American 
people,  and  as  the  most  important  function  of  the  home  is  the  bearing  and  rearing  of 
children  who  will  function  in  society  for  its  advancement,  we  believe  that  this  is  a 
measure  which  is  essential  to  conservation  of  the  most  precious  products  of  our  home 
life. 

There  are  in  this  country  about  20,000,000  home  makers.  Statistics  show  that  90 
per  cent  of  the  children  in  the  United  States  between  the  ages  of  14  and  16  are  out  of 
school  and  that  50  per  cent  of  these  have  only  a  fifth  grade  education  or  less.  This 
rneans  that  by  far  the  greater  majority  of  our  women  marry  and  assume  the  responsi- 
Ijility  of  parenthood  with  practically  no  training  for  this  particular  function  and  very 
little  general  education.  The  mortality  record  is  evidence  of  the  ignorance  on  the  part 
of  mothers,  as  undoubtedly  two-thirds  of  the  mothers  who  die  in  childbirth  could  be 
saved  if  they  had  thoroughly  understood  the  causes  and  symptoms  of  such  a  condition 
and  at  least  half  of  the  bal)ies  who  die  before  they  are  a  year  old  could  be  saved  if 
mothers  were  trained  in  the  fundamental  principles  of  child  care  and  feeding. 

The  association  believes  that  the  opportunity  should  be  open  to  every  woman  to 
secure  at  public  expense  training  in  the  fundarnental  responsibilities  which  comprise 
the  occupation  of  homemaking,  so  that  she  may  be  able  to  conduct  and  manage  a 


PUBLIC   PROTECTION   OF    MATERNITY   AND   INFANCY.  67 

home  where  a  healthy  haj)py  family  can  l)e  reared.  We,  therefore,  indorne  this 
measure  as  a  most  important  j)ie(e  of  echieational  lej^islation  and  as  a  foundation  for 
our  own  special  work  of  sprcsadinu:  the  knowledge  of  the  proper  care  of  children  and 
most  efficient  methodH  of  honieniakin.<r. 

The  membership  of  this  association  is  made  up  of  home  makers,  teachers  of  home 
making,  workers  in  home  economics  extension,  institutional  workers,  and  research 
workers  in  all  lines  for  the  betterment  of  living  conditions.  We  know  intimately  the 
needs  of  the  home  and  how  great  is  the  demand  for  this  legislation  which  will  aid  the 
States  in  pro\iding  the  essential  care  to  mother  and  bal)e.  We  protest  against  this 
great  pre\entable  annual  loss  of  life  and  register  an  urgent  appeal  that  Congress  enact 
this  law  which  will  give  immediate  relief  in  the  saving  of  many  thousands  of  lives  and 
which  is  a  fundamental  step  in  the  promotion  of  education  for  homemaking. 

Louise  Stanley, 
Legislative  Chairman  American  Home  Economics  Association 

Mr.  Towner.  Mr.  Chairman,  I  desire  sincerely  to  thank  the  committee  for  their 
attention  which  has  been  given  us. 

The  Ch.\irm.vn.  Then  if  you  are  through,  Judge,  the  Chair  will  state  that  we  will 
meet  to-morrow  morning  at  9.30  o'clock  and  continue  until  11,  and  the  opponents  of 
this  measure  will  be  expected  to  appear  at  that  time.  The  Chair  would  like  to  ask 
those  persons  who  desire  to  be  heard  in  opposition  to  this  bill  to  leave  a  record  of  their 
desire  with  the  clerk  of  the  committee  in  the  ofiice  of  the  committee  next  door  as 
soon  as  possible  after  11.30  this  morning,  so  that  the  schedule  can  be  made  up,  in 
order  to  save  time  and  for  the  purpose  of  facilitating  the  hearing.  The  meeting  is 
now  adjourned. 

(Whereupon,  at  11  a.  m.,  the  committee  adjourned  until  9.30  o'clock  a.  m.,  Saturday, 
July  16,  1921.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Saturday,  July  16,  1921. 

The  committee  met  at  9.30  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman) 
presiding. 

The  Chairman.  Gentlemen  of  the  committee,  the  hour  has  arrived  at  which  we 
were  to  begin  the  hearing  of  testimony  from  opponents  of  the  bill  under  consideration. 
Before  doing  so,  however,  the  Chair  wishes  to  state  to  the  committee  that  he  has 
received  as  the  chairman  of  the  committee,  leading  up  to  the  hearings,  various  com- 
munications of  one  sort  and  another  and  quite  a  variety  in  point  of  source,  bearing  on 
the  interest  of  people  in  having  some  legislation  passed,  and,  of  course,  all  directed 
toward  this  bill.  It  is  not  the  purpose  of  the  Chair  to  go  into  an  exhaustive  analysis 
of  those  letters.  They  have  come  from  all  kinds  of  associations  of  which  women  are 
members  and  from  many  individuals  and  from  men,  professors  in  colleges,  and  so  forth 
and  so  on.  A  summary  of  those  letters  in  the  affirmative,  which  we  will  call  the 
proponent  side,  up  to  this  morning  was  about  243.  Out  of  those  197  came  from  the 
State  of  Massachusetts  and  not  an  insignificant  number  from  the  city  in  which  I  live. 
Outside  of  Massachusetts  the  remaining  46  were  divided  among  about  14  States  where 
somebody  saw  fit  to  take  an  interest  in  this  matter  on  the  side  of  the  proponents. 
New  York  State  contributed  12,  Airginia  3,  Indiana  5,  California  3,  District  of  Colum- 
bia 3,  Pennsylvania  3,  North  Carolina  2,  and  8  or  10  other  States  one  each.  You  will 
notice  that  so  far  as  the  communications  to  the  committee  officially  are  concerned, 
Massachusetts  had  a  very  tremendous  and  unusual  interest  in  this  matter.  When 
we  come  to  consider  the  opponent's  side  I  will  make  a  report  then,  although  I  may 
say  in  passing  that  Massachusetts  again  came  quite  prominently  to  the  foreground. 

In  conversation  with  Judge  Towner  this  morning,  he  and  I  have  concluded,  if 
agreeable  to  the  committee,  to  have  some  typical  letters  read  into  the  record  and  read 
before  the  committee  at  a  later  meeting.  Judge  Towner  also  has  some  letters  in  his 
posession  and  those  I  have  will  be  available  for  his  scrutiny  and  mine,  as  chairman, 
if  you  please,  and  out  of  those  we  will  pick  enough  letters  to  indicate  the  types  and 
sources  from  which  they  have  come,  and  will  have  them  read  to  the  committee  and 
have  them  made  a  part  of  the  record.  When  that  has  been  done,  so  far  as  the  Chair 
can  understand  and  see,  the  case  of  the  proponents  has  been  fully  covered  as  to  its 
outline  of  the  case,  subject  to  later  presentation  by  arrangement  by  the  committee 
with  Judge  Towner. 

The  Chair  will  now  call  upon  Mrs.  Leatherbee,  if  she  is  in  the  room,  to  give 
testimony. 


m 

68  PUBLIC  PROTEOTIOIsr   OF  MATERNITY  AND  INFANCY. 

STATEMENT  OF  MRS.  ALBERT  T.  LEATHERBEE,  REPRESENTING 
MASSACHUSETTS  ANTISUFFRAGE  ASSOCIATION,  BOSTON, 
MASS. 

The  Chairman.  Mrs.  Leatherbee,  will  you  kindly  give  your  name,  whom  you  rep- 
resent, and  your  residence? 

Mrs.  Leatherbee.  Mrs.  Albert  T.  Leatherbee,  Boston,  Mass.  I  represent  the 
Massachusetts  Anti-Suffrage  Association,  composed  of  about  40,000  women  of  21  years 
of  age  and  over,  living  in  all  parts  of  the  Commonwealth  of  Massachusetts.  I  appear 
as  their  representative  and  not  personally. 

On  April  28,  1921,  I  appeared  before  the  Senate  Committee  on  Education  and 
Labor  as  the  representative  of  the  Massachusetts  Anti-Suffrage  Association  and 
opposed  this  bill  as  "paternalistic,  socialistic,  and  meddlesome  in  nature  and  of  no 
practical  value  for  the  objects  it  pretends  to  effect."  We  still  adhere  to  that  position 
but  I  shall  not  repeat  the  arguments  given  then  because  they  are  already  printed  on 
pages  52  and  53  of  the  report  of  that  hearing. 

The  chairman  of  the  Senate  committee.  Senator  Kenyon,  officially  requested  our 
association  to  present  suggestions  that  would  elimina;te  the  paternalistic  and  social- 
istic features.  But,  before  we  could  take  action.  Senator  Moses  submitted  his  amend- 
ment and  our  association  advised  the  committee  that  this  amendment  embodied  our 
ideas,  although  we  do  not  approve  of  any  Federal  action  on  the  subject. 

It  is  impossible  to  remove  the  paternalistic  features  of  the  bill,  because  any  legisla- 
tion of  the  Federal  Government  that  interferes  with  the  control  of  the  private  and 
personal  affairs  of  its  citizens  must  from  its  very  nature  be  paternalistic.  We  object 
to  this  measure  as  a  primary  move  of  National  Government  toward  bureaucratic  con- 
trol of  family  life. 

The  socialistic  phase  of  the  bill  is  also  impossible  of  elimination,  because  when  any 
State  endeavors  to  control  purely  personal  affairs  of  its  citizens,  such  as  the  right  to 
manage  their  own  family  matters,  its  action  is  necessarily  socialistic  and  can  not  be 
otherwise. 

The  chief  object  of  attack  in  the  battle  of  socialism  against  our  established  Christian 
civilization  is  the  family.  Socialists  know  that  so  long  as  the  legitimate,  legalized 
familj^  remains  the  unit  of  society,  they  can  never  control  the  State.  It  is  the  first 
necessity  to  break  up  the  family  that  amid  the  resulting  chaos  they  inay  endeavor  to 
build  a  society  based  upon  individualism  in  which  children  become  the  wards  of  the 
State. 

We  consider  it  inadvisable  to  have  a  Federal  bureau  managing  maternity  matters. 
We  feel  that  such  affairs  can  be  much  more  economically  and  practically  handled 
locally.  All  over  the  land  arises  a  cry  for  governmental  economy,  for  the  reduction 
of  the  cost  of  Government,  for  a  decrease  of  taxation.  We  feel  that  there  is  absolutely 
no  call  for  the  additional  expense  invoh^ed  in  this  bill,  small  as  a  few  extra  millions 
oi  dollars  may  seem  to  those  to  handle  the  people's  money. 

It  seems  to  be  the  present  legislative  tendency  everywhere  to  inaugurate  new  and 
expensive  departments  to  meddle  with  the  private  lives  of  indiAdduals.  Our  former 
ideas  of  government,  which  were  primarily  for  the  protection  of  life  and  property  of 
our  citizens  throughout  the  world,  are  being  replaced  by  theories  for  personal  guidance. 
A  group  of  self-constituted  mentors,  pseudo  supermen  and  superwomen,  has  arisen 
to  guide  our  actions  and  guard  our  morals.  It  would  almost  seem  as  though  there 
were  some  hidden  power  intent  upon  forcing  legislation  to  interfere  with  the  domestic 
relations  of  private  life.  As  a  result,  the  people  are  beginning  to  feel  a  mild  annoy- 
ance which  will  soon  develop  into  seething  unrest.  They  are  beginning  to  protest 
against  the  constant  endeavor  to  dictate  private  action.  Such  an  attitude  is  neither 
healthy  nor  normal  and  may  lead  to  very  grave  conditions  of  lawlessness.  And  a 
state  of  lawlessness  and  unrest  is  the  very  state  most  desirable  to  the  socialists.  There 
is  much  food  for  thought  in  all  this. 

Therefore,  we  ask  you  gentlemen  to  consider  all  these  phases  of  the  question,  as  well 
as  the  literal  phrasing  of  the  bill,  before  making  a  final  decision. 

If  it  be  necessary,  which  we  do  not  believe  it  to  be,  for  the  National  Government  to 
siipervise  the  pregnancy  of  the  country,  to  act  as  physician,  midwife,  and  nursemaid 
to  the  citizens,  we  beg  that  the  management  be  placed  in  the  hands  of  educated 
professionally  trained  persons  where  it  may  be  practically  carried  out  by  those  fitted 
for  the  work  and  not  left  in  the  hands  of  an  army  of  ignorant  amateurs. 

In  support  of  this,  I  wish  to  say  that  the  Boston  Medical  and  Surgical  Journal,  which 
is  the  organ  of  the  Massachusetts  Medical  Society,  owned  and  published  by  it,  and  the 
representative  medical  journal  of  New  England,  edited  by  Dr.  Walte/P.  Bowers, 
who  for  many  years  has  been  secretary  of  the  State  board  of  medical  registration,  came 
out  on  July  7  with  this  editorial — I  shall  not  read  the  whole  of  it  but.  simply  that 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  69 

portion  of  it  which  apjilics  to  this  matter.  It  is  headed,  "The  iSheppard-Towiicr 
Maternity  liill,  "  and  after  announcing  the  date  of  the  hearings,  July  12,  it  goes  on 
and  says: 

"There  is  great  and  growing  opposition  on  the  part  of  jjliysicians,  mothers,  medical 
societies,  and  all  sincere  o])ponents  of  bureaucracy  and  paternalism. 

"Senator  Moses  has  introduced  a  real  maternity  bill,  which  would  provide  local 
maternity  hospitals,  and  the  training  of  local  nurses,  imder  local,  county,  and  State 
authorities.  So,  if  you  are  in  favor  of  the  Federal  Government  doing  something  of 
benefit  in  this  matter,  be  sure  to  include  an  indorsement  of  'the  Moses  amendment '  if 
you  approve  it.  Some  persons  believe  that  even  the  'Moses  amendment'  would  lead 
to  abuses  and  final  concentration  of  power  in  a  Federal  bureau,  and  that  this  subject 
should  be  left  exclusively  with  the  States,  but  the  Moses  amendment  provides  for 
local  control  and  at  least  does  something  for  mothers  and  babies,  and  does  not  allow 
centralized  Federal  coercion. 

"The  Sheppard-Towner  'maternity'  bill,  on  the  contrary,  concentrates  full  power  in 
the  Federal  Children's  Bureau;  provides  nothing  but  'advice'  and  'investigation'  and 
'lectures'  and  'jobs';  actually  prohibits  the  use  of  any  part  of  the  fund  for  hospitals  or 
equipment  (sec.  13) — so  it  can  all  be  used  for  salaries — and  allows  the  Federal  Chil- 
dren's Bureau  to  send  out  propagandists  and  '  amateurs ' '  to  incur  such  travel  and  other 
expenses  as  it  may  deem  necessary.'     (Sec.  6.) 

"The  'maternity'  bill  propagandists  are  bitterly  opposed  to  the  'Moses  amendment.' 
They  don't  want  local  hospitals  for  mothers,  but  Federal  jobs  for  themselves  and  the 
expansion  of  the  United  States  Children's  Bureau  into  a  vast  'maternity  system'  as  in 
foreign  countries,  with  Mrs.  Kolontai's  system  as  their  ideal  of  'the  most  comj^re- 
hensive.' 

"Massachusetts  can  settle  this  question  for  itself  if  the  legislature  will  deal  with  it  in 
a  logical  manner.  The  Journal  contends  that  the  Federal  Government  should  restrict 
its  activities  to  the  dissemination  of  information  on  this  subject." 

That  is  from  the  recognized  authorized  authority  of  the  medical  profession  in  New 
England.  ' 

In  regard  to  the  cost. of  the  matter,  I  wish  to  read  very  briefly  a  certain  passage  from 
the  Boston  Transcript  of  July  9,  1921.  Those  of  you  gentlemen  who  are  not  familiar 
with  Boston  may  be  interested  to  know  that  the  Transcript  is  the  representative  family 
paper  of  New  England  and  probably  has  the  largest  evening  circulation  in  the  hoiue 
of  any  paper  in  that  section.  It  is  a  very  well-known  and  very  fine  old  paper.  While 
this  editorial  is  largely,  perhaps,  partisan  in  its  nature,  I  shall  read  only  those  portions 
which  refer  to  this  bill  which,  of  course,  is  opposed  from  a  perfectly  nonpartisan  stand- 
point. It  is  speaking  about  the  expenses  of  Government  and  taking  up  these  new 
legislative  ideas  for  new  departments,  etc.     It  says: 

"Grant,  for  the  sake  of  argument,  that  the  public  welfare  requires  a  new  department, 
especially  charged  by  law  with  its  care,  the  public  welfare  can  best  be  served  at  this 
time  by  cutting  down  the  cost  of  Government  as  a  first  step  toward  reducing  the  tax 
burden  that  is  bearing  down  so  heavily  upon  the  people.  Grant,  for  the  sake  of  argu- 
ment, that  public  education  requires  a  new  department  especially  charged  by  law 
with  its  promotion  and  control,  the  cause  of  public  education  can  best  be  served  at 
this  time  by  informing  the  men  and  women  above  school  age  concerning  the  true 
function  of  Government  and  the  obligations  of  the  Nation,  the  States,  and  the  munici- 
palities and  by  correcting  the  prevailing  impression  that  the  only  cure-all  is  legislation. 
Grant,  for  the  sake  of  argument,  that  training  for  motherhood  -will  reduce  the  rate  of 
infant  mortality  and  build  a  better  Nation,  if  the  people  of  the  municipalities  and 
States  of  the  Union  are  willing  to  admit  the  benefits  of  this  training  they  'vdW  tax 
themselves  in  their  own  communities  and  in  their  own  States  to  provide  it.  Why 
should  the  Nation,  in  this  economic  crisis,  be  called  on  to  pay  for  the  neglect  by  the 
States  and  municipalities  of  their  own  citizens? 

' '  Remember  that  it  is  in  the  \TLllages  and  the  cities  that  the  raids  upon  the  Treasury 
are  organized  in  behalf  of  many  new  schemes  now  pending  in  Congress  for  adding  to 
the  cost  of  Government  and  increasing  the  tax  burden.  Instead  of  rallying  to  the 
support  of  less  and  better  Government  at  a  lower  cost,  the  most  active  ainong  the 
newly  enfranchised  voters  appear  to  be  taking  the  lead  in  the  squandermania  that  is 
descending  upon  Congress.  Here  and  there  organizations  of  women  yotersare  bringing 
the  strongest  possible  pressure  to  bear  u|3on  Congress  for  the  creation  of  new  depart- 
ments.    They  appear  to  be  blind  and  deaf  to  the  condition  of  the  Treasury." 

In  closing  it  says: 

' '  The  man  or  the  woman  who  will  resolve  to  oppose  the  creation  of  any  new  depart- 
ment at  Washington  until  the  number  of  the  departments  in  existence  has  been  reduced 
by  consolidation,  to  oppose  the  opening  up  of  any  new  fields  of  Federal  activity  until 
the  taxes  have  been  reduced,  will  be  rendering  greater  service  to  the  welfare  of  the 


70  PUBLIC   PROTECTIOlSr    OF   MATERNITY  AND   INFANCY. 

Nation  and  the  Avorld  than  by  joining  any  one  of  the  organized  raids  upon  the  Treasury 
that  are  now  soliciting  new  recruits." 

That  is  all  I  have  to  say,  gentlemen. 

The  Chairman.  Do  the  members  of  the  committee  desire  to  question  Mrs. 
Leatherbee? 

Mr.  Graham.  Mrs.  Leatherbee,  I  wonder  if  I  understood  you  properly.  You  are 
opposed  to  governmental  interference  in  family  life? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Graham.  And  you  would  even  go  so  far  as  to  extend  that  to  the  State's  jurisdic- 
tion, would  you? 

Mrs.  Leatherbee.  Yes,  sir;  in  family  life. 

Mr.  Graham.  I  also  have  somewhat  the  same  ideas  in  my  mind,  but  just  how  far  in 
your  judgment  can  the  State — and  meaning  by  the  State  the  Government — how  far 
can  the  Government  go  properly  in  its  interference  with  the  family  life  with  safety  to 
the  country,  do  you  think? 

Mrs.  Leatherbee.  Well,  of  course,  the  Government  should  go  into  family  life  to  ' 
the  extent  of  preventing  the  family  from  doing  anything  which  is  wrong  or  is  contrary 
to  the  general  public  welfare  or  against  the  welfare  of  its  neighbors;  but  as  to  its  own 
personal  matters,  such  as  bringing  up  its  children,  if  those  children  are  not  brought 
up  in  a  way  which  is  detrimental  to  the  welfare  of  the  public,  I  should  certainly  not 
consider  it  the  duty  of  the  State  or  Government  or  municipality  to  meddle. 

Mr.  Graham.  Let  me  call  your  attention  to  a  few  laws  which  we  have  in  my  State, 
for  instance.  We  have  a  law  requiring  nurses  and  physicians  to  give  prophylactic 
treatment  to  children's  eyes  when  they  are  born.  Do  you  think  that  is  a  proper 
exercise  of  governmental  power? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Graham.  On  what  theory? 

Mrs.  Leatherbee.  Because  if  those  children  became  blind  they  would  become 
wards  of  the  Sta^e,  to  the  extent  that  they  would  have  to  be  supported  by  public  funds. 

Mr.  Graham.  But  suppose  the  child's  eyes  are  all  right. 

Mrs.  Leatherbee.  You  can  not  tell  whether  they  are  all  right  or  not. 

Mr.  Graham.  Therefore,  the  Government  is  justified  in  stepping  in  in  order  to 
insure  the  health  and  welfare  of  that  child,  and  by  so  doing,  indirectly,  the  State  is 
helped. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Graham.  I  agree  with  you  about  that.  Now,  do  you  think  that  the  child-labor 
laws  are  proper? 

Mrs.  Leatherbee.  I  am  not  an  expert  on  child  labor  and  I  should  hesitate  to  say. 

Mr.  Graham.  I  mean  the  kind  of  laws  that  say  that  a  child  under  14  years  of  age, 
we  will  fay,  can  not  work  without  the  permit,  for  instance,  in  some  places,  of  certain 
public  officials,  and  such  public  officials  do  not  consult  the  wishes  of  the  members  of 
the  child's  family.     Do  you  consider  that  kind  of  legi-lation  as  proper? 

Mrs.  Leatherbee.  I  do  not  know  that  my  personal  opinion  would  be  worth  much 
on  that.  I  am  frank  to  say  that  I  think  in  many  cases  where  the  child  labor  law 
prohibits  children  imder  14  years  of  age  from  working,  in  individual  cases  it  is  not 
always  wise;  but  that  is  merely  my  personal  opinion.  I  could  not  speak  for  my 
association  on  that. 

Mr.  Graham.  Suppose,  for  instance,  the  power  is  taken  out  of  the  hands  of  the 
parents  to  say  whether  a  child  shall  work  or  not,  and  that  is  true  in  several  States, 
do  you  think  that  is  right? 

Mrs.  Leatherbee.  No;  personally,  I  do  not. 

Mr.  Graham.  The  State  is  given  that  jurisdiction  in  some  cases. 

Mrs.  Leatherbee.  Yes;  but  simply  because  jurisdiction  is  given  in  some  cases 
does  not  make  it  any  more  advisable  to  use  it  in  other  cases. 

Mr.  Graham.  Do  you  believe  in  the  dependency  and  delinquency  laws  in  force 
in  many  States  by  which  the  public  takes  upon  itself  the  power  and  right  to  go  into 
your  home  and  mine  and  say  whether  we  are  raising  our  children  properly? 

Mrs.  Leatherbee.  Personally,  I  do  not. 

Mr.  Graham.  It  is  done;  you  know  that. 

Mrs.  Leatherbee.  I  know  lots  of  things  are  done  but  still  I  personally  do  not 
approA'e  of  them,  and  when  I  answer  these  questions,  you  understand.  Mr.  Graham, 
I  have  to  answer  them  according  to  my  personal  opinions,  because  I  have  no  au- 
thority from  the  people  whom  I  represent  to  speak  along  these  particular  lines. 

Mr.  Graham.  I  understand  that,  and  I  am  simply  trying  to  get  your  viewpoint. 

Mrs.  Leatherbee.  My  personal  opinion. 

Mr.  Graham.  In  many  States  it  is  the  law  that  children  before  they  go  to  school 
must  submit  to  certain  physical  examinations  and  from  time  to  time  be  examined 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  71 

and  be  treated  so  that  they  may  be  immune  to  certain  diseases,  such  as  smallpox 
do  you  think  those  are  proper  exercises  of  governmental  functions? 

Mrs.  Leatiierbee.  Certainly  I  do,  because  otherwise  that  child  might  be  a  menace 
to  the  rest  of  the  children  in  the  community. 

Mr.  Graham.  Then  on  a  parity  of  reasoning  I  am  wondering  why  the  States  them- 
selves can  not  exercise  similar  powers  and  functions  as  to  the  regulations  of  the  h)irth 
of  children  in  the  way  of  assistance  and  supervision,  if  you  please,  so  that  the  health 
of  the  child  will  be  as  good  as  is  possible. 

Mrs.  Leatherbee.  That  is  exactly  the  stand  which  is  taken  by  my  association. 
We  see  no  reason  why  the  Federal  Government  should  go  into  these  matters.  In 
Massachusetts  we  attend  to  them  very  nicely  locally.  \Ye  have  some  45  general 
hospitals  which  take  maternity  cases  and  we  have  about  one  dozen  hospitals  which 
have  nothing  but  maternity  cases.  The  Boston  Lying-in  Hospital  is  probably  the 
pioneer  in  work  of  this  sort,  and,  in  Massachusetts,  the  people  who  are  interested  in 
child  welfare  and  who  are  interested  in  prenatal  work  are  very  strongly — that  is, 
those  I  have  talked  with,  and  I  have  talked  with  most  of  them — are  very  strongly  in 
favor  of  leaving  this  matter  in  the  hands  of  the  local  authorities,  and  the  local  private 
associations.  They  are  getting  along  very  nicely.  They  are  doing  very  well.  They 
do  not  care  to  be  meddled  with  and  they  do  not  care  to  be  under  any  supervision 
which  they  consider  is  not  of  an  absolutely  professional  nature. 

Mr.  Graham.  Then  your  objection  is  not  a  fundamental  objection  to  the  State 
doing  this,  but  your  objection  is  principally  based  upon  the  proposition  that  you 
think  it  is  a  local  matter  and  that  ought  to  be  attended  to  by  the  State  or  by  the  local 
municipality. 

Mrs.  Leatherbee.  We  feel  that  whatever  is  done  should  be  done  locally.  We 
have  an  excellent  health  department  in  Boston.  We  have  excellent  health  depart- 
ments all  over  the  Commonwealth,  and  those  departments  in  connection  with  the 
various  private  organizations  are  attending  to  this  business  now,  and  they  are  doing 
it  well,  and  they  do  not  care  to  be  interfered  with,  and  mv  association  believes  that 
this  matter  of  prenatal  care  or  the  care  of  the  infant  is  a  purelv  professional,  medical 
matter;  that  it  is  not  a  matter  of  sociology  or  a  matter  of  economics;  that  it  is  primarily 
and  fundamentally  professional,  medical  work. 

Mr.  Graham.  I  am  glad  to  get  your  view,  because  I  rather  gathered  from  your 
statement  that  you  were  opposed  to  the  thing  on  principle,  but  I  see  now  that  that 
is  not  the  fact.  What  you  are  principally  opposed  to  in  this  bill  is  the  Federal  element 
in  it. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Newton.  Right  along  that  line,  AIi-s.  Leatherbee,  I  understood  that  you 
appeared  before  the  Senate  committee  and  opposed  a  similar  measui-e  pending  there, 
principally  upon  the  ground  that  it  was  socialistic  and  paternalistic. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Newton.  And  also  upon  the  ground  that  it  was  an  unAvarranted  exercise  by 
the  Federal  Government  of  i^owers  belonging  to  the  States  or  the  localities.  The 
objection  that  it  is  socialistic  and  paternalistic  would  seem  to  me  to  apply  whether 
that  work  is  carried  on  by  the  Federal  Government  or  by  the  States. 

Mrs.  Leatherbee.  I  think,  if  I  remember  correctly,  I  said  this  bill  was  socialistic 
and  paternalistic,  and  of  course,  if  a  thing  is  done  locally  in  a  city  and  done  under  an 
appropriation  which  is  given  by  the  city  council  or  the  board  of  aldermen,  or  what- 
ever the  authority  of  the  city  may  be  which  appropriates  the  money,  and  is  carried 
out  by  the  health  department  of  that  city,  that,  of  course,  is  purely  a  local  matter. 
A  bill  could  be  drawn  which  would  apply  locally;  that  is,  an  ordinance  would  be 
issued  b}''  the  city  government  which  would  cover  all  the  desirable  features  that  are 
intended  to  be  covered  in  this  bill  \vithout  hai'ing  the  undesirable  ones. 

Mr.  Newton.  Now,  take  this  as  an  illustration:  I  believe  you  were  in  the  room  here 
in  the  last  few  days  and  heard  the  testimony  of  Dr.  Baker,  of  New  York  City? 

Mrs.  Leatherbee.  I  had  the  pleasure  of  hearing  some,  butnotall,  of  her  statement. 

Mr.  Newton.  She  related  the  work  being  carried  on  by  the  city  of  New  York 
which  appealed  to  me  as  a  very  worthy  work,  as  to  prenatal  care  and  as  to  instructing 
mothers  in  the  care  of  babies.  Some  people  would  call  that  socialistic  and  paternal- 
istic. 

Mrs.  Leatherbee.  No,  sir;  I  think  that  the  work  which  is  being  done  by  the  health 
authorities  of  the  respective  large  cities  is  a  very  excellent  work.  As  I  understand 
that  work,  and  I  presume  it  is  the  same  as  it  is  in  Boston,  it  is  largely  a  matter  of 
clinics  and  a  matter  of  advising  people  who  come  in  and  apply  for  adAice. 

Mr.  Newton.  Then,  so  far  as  that  particular  work  is  concerned,  you  do  not  term 
that  as  meddlesome? 

Mrs.  Leatherbee.  Oh,  no;  that  is  a  local  matter,  and  they  do  not  go  out  and 
meddle  with  people.     The  people  come  to  them. 


72  PUBLIC  PROTECTION   OF  MATERNITY  AND  INEANCY. 

Mr.  Newton.  Now,  what  I  am  getting  at  is  this:  As  I  understand  the  provisions  of 
this  bill,  it  is  to  stimulate  interest  in  these  different  matters  by  the  States.  Wherein 
do  you  claim  that  by  the  enactment  of  this  bill  the  Government  would  be  meddling 
with  the  families  and  meddling  in  family  life? 

Mrs.  Lbathbrbbe.  In  my  opinion  the  latitude  of  the  bill  is  so  very  remarkable 
that  perhaps  it  is  as  dangerous  for  what  it  does  not  say  as  for  what  it  does  say;  you 
place  control  of  a  matter  of  this  sort  in  a  Federal  bureau  and  that  Federal  bureau  has 
the  right  to  tell  the  different  organizations  that  are  working  under  it  what  they  shall 
do  and  then  you  certainly  have  a  paternalistic  control,  or  a  maternalistic  control,  if 
you  prefer  that  term. 

Mr.  Newton.  The  Federal  Government,  as  I  understand  the  intent  of  the  framers 
of  the  law — I  am  not  thoroughly  conversant  with  every  detail  of  its  phraseology, 
because  I  have  not  given  it  that  close  study — but  as  I  understand  it,  the  only  control 
that  would  be  exercised  by  the  Federal  Government  would  be  to  see  that  the  general 
purpose  of  the  act  is  carried  out;  so  that  if  $10,000  is  given  to  a  State  they  will  know, 
in  a  general  way,  that  it  is  being  spent  in  accordance  with  the  general  purpose  of  the 
act.  I  do  not  see  that  there  is  anything  in  the  bill,  as  proposed,  which  does  any  more 
than  that.  That  being  the  case,  the  manner  of  administration,  the  matter  of  the 
expenditure  of  this  money,  and  such  visitation  as  may  be  done  in  connection  with  it, 
may  be  purely  a  matter  for  the  individual  localities  or  for  the  States,  so  that  I  can  not 
see  how  there  could  be  any  objection  to  the  bill  so  far  as  being  paternalistic  or  social- 
istic is  concerned,  unless  we  go  back  to  Herbert  Spencer's  theory  that  every  kind  of 
government,  even  that  of  public  education,  is  paternalistic  and  socialistic. 

Mrs.  Leatherbee.  Did  you  ask  me  a  question? 

Mr.  Newton.  I  was  simply  stating  the  fact  that  I  was  unable  to  get  your  point  of 
view  from  such  reading  of  the  bill  that  I  have  been  able  to  do,  that  under  this  bill 
the  Government  could  go  into  the  States  and  meddle  with  the  family  life.  I  can  not 
get  your  point  of  view  on  that. 

Mrs.  IjEatherbee.  I  think  if  you  will  read  the  bill  very  carefully,  Mr.  Newton, 
you  will  see  that  in  there. 

Mr.  Newton.  I  intend  to  read  it  more  carefully,  but  the  general  purpose  of  the 
bill 

Mrs.  Leatherbee  (interposing).  The  intentions  of  the  proponents  of  the  bill  I 
believe  are  very  excellent  in  their  desires,  but  I  do  not  think  that  this  bill  will  carry 
out  those  things  which  they  claim  to  desire,  and  I  think  it  gives  a  tremendous  latitude 
and  establishes  a  very  remarkable  precedent. 

Mr.  Newton.  Of  course,  if  the  Government  is  going  to  expend  any  money  you 
would  want  some  authority  in  the  Federal  Government  to  check  up  and  find  out 
whether  the  States  were  using  the  funds  for  maternity  purposes,  or  whether  they 
were  being  used  for  some  entirely  different  purpose.  That,  of  course,  would  have  to 
follow.     Would  you  favor  the  bill  if  it  did  not  do  more  than  that? 

Mrs.  Leatherbee.  Who  is  going  to  check  up  on  this  thing? 

Mr.  Newton.  Well,  the  Public  llealth  Service,  or  the  Children's  Bureau,  or  what- 
ever organization  of  the  *Government  as  would  be  designated  by  Congress  as  the 
administrative  body. 

Mrs.  Leatherbee.  Of  course,  our  opinion  would  vary  as  to  which  department  was 
to  do  this  checking  up. 

Mr.  Newton.  No;  I  mean  simply  some  department  of  the  Government. 

Mrs.  Leatherbee.  I  do  not  exactly  comprehend  what  you  have  in  mind. 

Mr.  Newton.  You  and  I  agree  that  if  the  Government  is  going  to  expend  any  money 
for  this  purpose,  there  should  be  some  department  of  the  Government  that  would  see 
that  the  money  is  expended  along  general  lines  for  this  purpose. 

Mrs.  Leatherbee.  Of  course. 

Mr.  Newton.  Then  I  believe  you  mentioned  that  it  would  depend  upon  what 
department  of  the  Government  it  was  placed  under. 

Mrs.  Leatherbee.  Yes. 

Mr.  Newton.  I  agree  with  you  to  this  extent;  I  think  one  branch  of  the  Govern- 
ment might  exercise  the  power  much  more  wisely  and  better  than  another  branch  of 
the  Government.  I  am  inclined  to  agree  with  you  that  this  is  more  medical  than 
a  question  of  sociology  and  general  welfare  work.  If  this  work  is  to  be  done,  you 
would  prefer  to  have  it  done  by  the  Public  Health  Service? 

Mrs.  Leatherbee.  Most  certainly.  If  it  be  necessary  for  the  Government  to  take 
such  a  matter  in  charge,  we  naturally  would  prefer  that  it  should  be  done  by  regularly 
educated  physicians. 

Mr.  Barkley.  I  believe  you  speak  for  the  Massachusetts  Association  Opposed  to 
Woman's  Suffrage? 

Mrs.  Leatherbee.  It  is  the  same  thing,  although  the  name  is  a  little  different — 
the  Massachusetts  Anti-Suffrage  Association. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  73 

Mr.  Bahkmcy.  I  suppose  in  spite  of  the  course  of  events  the  association  ia  keeping 
up  its  organization? 

Mrs.  Leatherbek.  We  are  keepij)^  up  our  organization  until  the  Supreme  Court 
renders  its  decision  as  to  the  legality  of  the  nineteenth  amendment. 

Mr.  Barkley.  I  do  not  just  get  the  connection  between  an  association  opposed  to 
woman's  suffrage  and  lliis  bill. 

Mrs.  Leatherbee.  Of  course,  the  Massachusetts  Anti-Suffrage  Association  is  not 
appearing  here  as  an  antisuffrage  association,  although,  of  course,  that  is  the  name  of 
the  organization,  and  the  purpose  for  which  it  was  established  some  25  years  or  more 
ago.  It  is  appearing  here  as  an  organization  of  conservative  Massachusetts  women 
who  are  opposed  to  this  measure. 
Mr.  Barkley.  I  did  not  get  quite  clearly  in  my  mind  whether  your  opposition, 

and  when  I  say  your  opposition  I  mean  the  opposition  of  your  society 

Mrs.  Leatherbee.  Certainly. 

Mr.  Barkley  (continuing).  Is  based  on  the  theory  that  the  Government  owes 
nothing  to  the  people  in  the  way  of  maternity  and  child  hygiene. 

Mrs.  Leatherbee.  You  put  it  in  a  rather  peculiar  way.  Of  course,  we  believe  that 
the  Government  owes  a  gi'eat  deal  to  its  citizens  in  every  particidar,  but  we  feel  that 
it  may  best  show  that  indebtedness  by  leaving  them  alone  to  a  certain  extent  to  work 
out  their  own  salvation. 

Mr.  Barkley.  Do  you  believe,  or  does  your  association  believe,  in  compulsory 
education  of  children? 

Mrs.  Leatherbee.  I  do  not  know.  It  has  never  taken  any  stand  on  it.  I  pre- 
sume it  does.     You  mean  in  the  public  schools? 

Mr.  Barkley.  Y^es. 

Mrs.  Leatherbee.  Yes;  I  do. 

Mr.  Barkley.  Upon  what  theory? 

xMrs.  Leatherbee.  Because  it  is  for  the  welfare  of  the  whole  country.  It  is  not  a 
matter  of  the  education  of  that  individual  child  or  the  welfare  of  that  individual 
child,  it  is  how  that  education  ■will  react  upon  the  whole  country.  As  I  understand 
it,  our  form  of  government  is  based  on  what  is  for  the  welfare  of  the  majority  and  not 
the  individual. 

Mr.  Barkley.  So  you  do  believe  that  the  Government  ought  to  meddle  in  the 
family  so  far  as  education  is  concerned. 

Mrs.  Leatherbee.  I  should  hardly  call  that  meddling,  because  the  Government 
allows  any  family  to  educate  its  child  as  it  sees  fit.  It  does  not  say  that  every  child 
shall  go  to  a  public  school. 

Mr.  Barkley.  No,  but  if  they  see  fit  not  to  educate  them  anywhere,  the  State 
steps  in  and  takes  charge. 

Mrs.  Leatherbee.  And  say  that  they  must  educate  them  but  they  have  a  choice 
as  to  where  they  shall  bo  educated  and  how  they  shall  be  educated. 

Mr.  B.\rkley.  Do  you  believe  in  compulsory  vaccination? 

Mrs.  Leatherbee.  Certainly. 

Mr.  Barkley.  Upon  what  theory? 

Mrs.  Leatherbee.  Upon  the  theory  that  if  children  are  not  vaccinated  they  be- 
come a  menace  to  the  health  of  the  community. 

Mr.  Barkley.  And  therefore  may  produce  or  cause  the  death  of  indi\'iduals  in  the 
community. 

Mrs.  Leatherbee.  Yes. 

Mr.  Barkley.  Y^ou  are  in  favor  then  of  compulsory  vaccination  because  if  the 
disease  is  contracted  and  spread  it  may  result  in  death. 

Mrs.  Leatherbee.  It  results  not  only  in  death  but  it  residts  in  great  damage  to 
the  community. 

Mr.  Barkley.  What  is  the  other  damage,  in  addition  to  the  damage  produced  by 
death.     You  are  speaking  now  of  the  economic  loss? 

Mrs.  Leatherbee.  Of  course,  if  you  have  a  large  epidemic,  you  suffer  all  sorts  of 
losses;  b\it.  primarily,  as  I  understand  it,  compiilsory  vaccination  is  to  prevent  that 
child  from  becoming  a  source  of  infection  to  the  children  and  to  the  rest  of  the  com- 
munity. 

Mr.  Barkley.  Now,  let  me  ask  you 

Mrs.  Leatherbee.  Pardon  me  just  a  moment.  In  answering  these  (luestions.  you 
are  asking  me  these  questions  personally? 

Mr.  Barkley.  Yes. 

Mrs.  Leatherbee.  I  have  no  authority  from  my  association  to  say  anything  on 
these  subjects. 

Mr.  Barkley.  How  do  you  difierentiate  between  the  interference  of  the  State  to 
compel  the  vaccination  of  an  indi\'idual  in  order  to  prevent  the  death  of  some  other 


74  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

individual  or  its  own  death  and  the  interference  of  the  State  to  prevent  the  death  of 
a  mother  who  brings  that  child  into  being,  or  the  child  itself  after  it  is  brought  into 
being? 

Mrs.  Leatherbee.  Maternity  is  not  contagious. 

Mr.  Baekley.  No,  but  is  rather  widespread. 

Mr.  Johnson.  Mr.  Chairman,  I  think  we  ought  to  have  order.  I  object  to  that 
because  I  think  this  is  too  serious  a  proposition. 

The  Chairman.  What  is  your  objection,  Mr.  Johnson? 

Mr.  Johnson.  I  object  to  making  sport  of  what  the  witness  says  here. 

Mrs.  Leatherbee.  I  had  no  intention  of  making  sport  of  it. 

Mr.  Johnson.  I  understand  that. 

The  Chairman.  I  think  we  may  go  on  with  the  proceedings. 

Mr.  Barkley.  I  do  not  quite  yet  see  the  difference  between  the  theory  under 
which  it  is  the  duty  of  the  Government  to  compel  somebody  to  undergo  some  sort  of 
physical  t  orture  in  order  to  save  its  own  life  or  the  life  of  somebody  else,  and  the  theory 
which  also  puts  the  Government  into  an  activity  that  may  prevent  the  death  of  an 
individual  or  groups  of  individuals  from  other  causes. 

Mrs.  Leatherbee.  Of  course,  I  am  not  an  expert  on  epidemology  or  anything  of 
that  sort,  but  it  seems  to  me  a  very  plain  line  can  be  drawn  between  allowing  a  child 
to  associate  with  other  children  in  a  school  and  perhaps  be  the  source  of  carrying  a 
very  frightful  epidemic  disease  into  other  families  and  the  matter  of  State  investiga- 
tion as  to  the  prenatal  condition  of  individual  women. 

Mr.  Barkley.  Let  us  take  two  families  living  side  by  side  as  an  example,  and  one 
of  those  families,  we  will  say,  has  tliree  or  four  children.  They  have  arrived  at  the 
age  of  from  4  or  5  years  up  to  10  years,  and  one  of  them  contracts  some  contagious 
disease  which  may  result  in  its  own  death  or  in  the  death  of  others.  Next  door  is  a 
family  where  the  wife  has  either  given  birth  to  a  child  or  is  about  to  do  so,  and  through 
her  ignorance  or  her  poverty  or  a  combination  of  ignorance  and  poverty,  she  is  either 
liable  to  lose  her  own  life  or  the  life  of  the  child.  Now,  where  is  the  difference  in  the 
value  of  those  two  lives  as  represented  in  those  two  families  so  far  as  the  Government 
is  concerned,  which  would  compel  the  Government  to  interfere  in  one  case  but  would 
compel  it  to  keep  its  hands  entirely  off  in  the  other  case. 

Mrs.  Leatherbee.  Do  you  refer  to  quarantine  measures? 

Mr.  Barkley.  I  refer  to  any  sort  of  health  measure  or  any  sort  of  interference  on 
the  part  of  the  Government,  with  respect  to  one  family  and  withholding  its  arm  from 
such  interference  with  another  family. 

Mr.  Rayburn.  Has  the  Federal  Government  ever  passed  any  law  regulating  the 
matter  of  vaccination  or  has  the  Federal  Government  in  any  way  interfered  in  that? 

Mr.  Barkley.  No;  that  is  not  the  question.  I  have  been  discussing  the  question 
of  what  she  has  said  was  the  duty  of  the  Government,  it  makes  no  difference  whehter 
it  is  the  State  or  Federal  Government. 

Mr.  Rayburn.  It  is  a  question  of  whether  the  Federal  Government  should  go  into 
this  field. 

Mr.  Barkley.  I  was  speaking  broadly  of  the  Government's  duty,  and  I  am  not 
distinguishing  between  the  State  government  and  the  Federal  Government  with 
respect  to  these  matters  affecting  the  welfare  of  the  people. 

Mr.  Rayburn.  May  I  interpose  again?  In  the  first  place  that  is  getting  away  from 
the  premise  that  she  laid  down.  She  does  not  object  to  Massachusetts,  Kentucky, 
or  other  States  performing  this  function,  but,her  premise  is  laid  upon  the  proposition 
that  it  is  not  a  Federal  function. 

Mrs.  Leatherbee.  Yes,  sir.     - 

Mr.  Rayburn.  The  same  objection  would  apply  to  compulsory  education  under  a 
Federal  law? 

Mrs.  Leatherbee.  Yes,  sir;  it  is  a  matter  of  home  rule  and  State  rights. 

Mr.  Barkley.  Did  I  understand  you  to  say  that  it  is  the  duty  of  the  State  to  do 
those  things  with  reference  to  maternity  and  infancy? 

Mrs.  Leatherbee.  Personally,  I  do  not  object  to  it.  There  is  one  thing  that  I 
would  like  to  say  in  regard  to  vaccination,  that  you  object  to — — ■ 

Mr.  Barkley  (interposing).  I  do  not  object  to  it. 

Mrs.  Leatherbee.  I  should  say  compulsory  vaccination.  In  Massachusetts, 
vaccination  is  compulsory  to  children  going  to  the  public  schools.  That  is  true  m 
Massachusetts,  but  I  do  not  know  as  to  the  rest  of  the  country.  If  people  there  ob  ect 
to  having  their  children  vaccinated,  they  do  not  have  to  send  them  to  the  public 
schools.  It  is  only  in  connection  with  the  public  schools  in  Massachusetts  that  vac- 
cination is  compulsory. 

Mr.  Barkley.  Speaking  generally,  all  health  regulations  in  a  State  apply  to  all  the 
people  of  the  State  without  exemption,  do  they  not? 

Mrs.  Leatherbee.  Yes,  sir. 


I 


PUBLIC  PROTECTION'   OF   MATERNITY  AND  INFANCY.  75 

Mr.  Barkley.  I  \va>s  correct  in  the  assumption  that  you  opposed  this  matter  upon 
the  principle  involved,  whether  the  power  was  exercised  by  the  State  or  the  Nation? 

Mrs.  Leatheiihee.  Certainly;  yes,  sir.  Our  association,  and  I  can  only  speak  for 
them  in  this  matter,  object  to  it  because  it  is  taking  over  a  State  and  city  affair  by  the 
Federal  Government. 

Mr.  BAUKr,EY.  But  your  association  has  not  gone  on  record  in  favor  of  it  even  as  a 
State  matter? 

Mrs.  Leatherbee.  No,  sir. 

Mr.  Barkley.  vSo,  if  I  gather  it  correctly,  you  are  in  favor,  or  you  do  not  object  to 
certain  activities  on  the  part  of  the  State,  although  compulsory,  that  tend  to  preserve 
the  health  and  life  of  certain  individiials  in  such  communities,  but  that  you  do  object 
to,  or  are  ojiposod  to,  those  activities  as  applied  to  certain  other  individuals  covered 
in  this  particular  bill? 

Mrs.  LE.\TirEi{HEE.  I  do  not  think  that  anybody  to-day  has  any  question  about 
being  willing  to  conform  to  the  resolutions  and  injunctions  of  the  pul)lic  health  de- 
partment of  its  own  locality.  Everybody  realizes  that  those  resolutions  are  made  for 
the  benefit  of  the  community,  and  I  have  never  heard  that  question  raised  anywhere. 

Mr.  Baukley.  Do  you  think  that  work  of  this  character  is  needed  anywhere? 

Mrs.  Leatherbee.  What  do  you  mean  by  "work  of  this  character?  " 

Mr.  Barki-ey.  I  mean  the  education  of  women  with  reference  to  their  own  care 
and  the  care  of  their  children,  either  before  or  after  birth. 

Mrs.  TiEATHEUBEE.  I  think  that  is  a  very  essential  thing,  and  in  Boston  and  in 
Massachusetts,  I  think  it  is  already  being  done  very  well. 

Mr.  Bakkley.  I  suppose  that  is  true,  but  suppose  it  is  true  that  in  other  sections  of 
the  country,  where  they  are  not  so  favorably  situated  in  that  respect  as  in  Boston  and 
New  York,  it  is  not  being  done.  Assuming  that  it  is  a  work  that  ought  to  be  done,  do 
you  still  contend  that  the  Government  ought  not  to  interfere  and  offer  its  services  in 
that  respect? 

Mrs.  Leatherbee.  Speaking  personally,  I  think  that  if  in  the  parts  of  the  country 
you  mention — and  I  do  not  know  what  localities  you  refer  to — but,  I  think  if  there  is 
a  demand  for  that  sort  of  thing,  the  people  should  take  it  up  with  their  own  authorities. 
I  have  lived  in  other  places  besides  Boston  and  Massachusetts,  and  I  find  that  there 
is  a  strong  feeling  all  over  this  country,  and  it  is  gro\^'ing  stronger  all  the  time,  that  the 
people  should  control  in  their  local  matters,  and  should  place  them  in  the  hands  of 
of  the  local  people. 

Mr.  Barkley.  Do  you  believe  that  the  feeling  is  growing  for  or  against  that? 

Mrs.  Leatherbee.  The  feeling  is  growing  for  local  self  government. 

Mr.  Barkley.  You  do  not  know  that  practically  all  of  the  so-called  encroachments 
of  the  Federal  Government  upon  the  authority  of  the  State  has  been  brought  about 
by  the  demand  of  the  people  on  account  of  the  neglect  of  the  State  to  bring  about  the 
conditions  which  they  desire? 

Mrs.  Leatherbee.  I  am  no  authority  on  that,  but  I  fancy  that  that  might  have 
been  brought  about  by  an  active  minority. 

Mr.  Barkley.  Do  you  mean  that  a  minority  of  the  people  can  compel  Congress  to 
do  those  things? 

Mrs.  Leatherbee.  I  did  not  say  that  they  could  compel  Congress,  but  I  think 
that  well  organized  minorities  have  very  powerful  effects. 

"Mr.  Cooper.  Mrs.  Leatherbee,  I  want  to  ask  you  a  few  questions,  and  I  will  not 
tire  you  any  more  than  I  can  help.  You  appeared  before  the  Senate  committee  on 
April  28,  and  opposed  the  consideration  of  this  bill? 

Mrs.  Leatherbee.  Yes,  sir.     However,  the  bill  is  a  little  bit  different. 

Mr.  Cooper.  It  was  this  same  bill,  according  to  Judge  Towner's  statement.  This 
is  the  bill  as  amended  by  the  Senate  committee. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Cooper.  I  have  a  copy  of  the  hearings  before  the  Senate  committee  here,  and 
I  find  that  you  made  this  statement:  , 

"Marx  and  Engels  preached  destruction  of  the  family,  and  their  followers  have 
never  repudiated  this  teaching.  But  our  socialists,  our  radicals,  our  atheists,  although 
they  openly  preach  enmity  to  the  family,  dare  not  bring  warfare  against  it  at  once. 
They  seek  its  destruction  by  insidious  and  indirect  means.  They  are  beginning  with 
legislation  that  pretends  to  benefit  the  family.  They  come  garbed  in  sheep's  clothing, 
but  their  nature  is  lupine,  and  we  must  be  on  our  guard. 

"After  2,000  years  of  Christian  ci\ilization,  are  we  to  progress  in  a  circle  until  we 
get  back  to  the  pagan  standards  of  ancient  Sparta  and  the  Code  of  Lycurgus,  800  years 
before  Christ,  and  regard  the  child  as  the  property  of  the  State  and  the  function  of 
parenthood  mere  machinery  by  which  citizens  are  produced?" 

In  the  next  paragraph  you  say: 


76  PUBLIC  PROTECTION   OF   MATERITITY  AND   INFANCY. 

"The  bill  is  meddlesome  because  it  allows  agents — I  do  not  say  that  it  provides 
for — ^it  allows  agents  of  a  Federal  bureau  to  invade  the  homes  of  our  people  and  sub- 
ject prospective  mothers  to  annoyance  and  insult  in  the  most  personal  and  delicate- 
relation  of  life." 

Now,  the  questions  I  want  to  ask  you  are  these:  Do  you  believe  that  the  authors 
of  this  bill,  and  all  of  those  organizations  that  have  indorsed  it  have  any  such  thing 
in  mind  as  you  stated  before  the  Senate  committee? 

Mrs.  Leatherbee.  I  think,  Mr.  Cooper,  if  you  will  read  the  rest  of  those  remarks 
of  mine  on  this  question,  you  will  find  the  ansewr  there.     Mr.  Kenyon  asked  me  the 
very  same  thing,  and  I  said,  "No;  certainly  not.     I  do  not  believe  that  these  people 
intentionally  have  any  desire  to  wreck  the  home, ' '  but  lots  of  things  are  done  unin 
tentionally. 

Mr.  Cooper.  Then,  I  want  to  ask  you  this  question:  Why  did  you  make  that 
statement  in  opposing  this  measure? 

Mrs.  Leatherbee.  Because  that  statement,  in  ouj  opinion — and  I  am  speaking  for 
my  association — ^is  absolutely  true. 

Mr.  Cooper.  Do  you  believe  that  in  this  measure  there  is  involved  a  principle  of 
that  character? 

Mrs.  Leatherbee.  I  do. 

Mr.  Cooper.  Do  you  also  believe  that,  if  this  measure  becomes  a  law.  Federal 
agents  will  invade  the  sanctity  of  the  home  and  subject  prospective  mothers  to  annoy- 
ance and  insult? 

Mrs.  Leatherbee.  That  is  perfectly  allowable,  so  far  as  the  bill  is  concerned. 

Mr.  Cooper.  Will  you  please  point  that  out? 

Mrs.  Leatherbee.  That  is  what  you  can  not  point  out.  That  is  one  of  those  things 
which  make  me  claim  that  the  bill  is  more  dangerous  from  what  it  does  not  stipulate 
than  from  what  it  does  stipulate.  There  is  nothing  in  the  bill  that  will  prevent  those 
agents  of  the  Children's  Bureau  from  going  into  homes  and  subjecting  prospective 
mothers  to  annoyance.     There  is  no  limitation  placed  upon  them. 

Mr.  Cooper.  You  were  present  the  other  day  when  Dr.  Baker  testified,  were  you 
not;  or,  at  least,  you  heard  a  part  of  her  testimony? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Cooper.  You  recall  that  she  stated  that  in  New  York  it  was  all  voluntary  on  the 
part  of  the  mothers? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Cooper.  Is  there  anything  in  this  bill  that  would  compel  a  mother  to  be  sub- 
jected to  that  annoyance? 

Mrs.  Leatherbee.  It  is  just  as  I  stated,  there  is  nothing  in  it  that  would  compel 
them  to  submit,  but  there  is  nothing  to  prevent  it.  What  Dr.  Baker  was  talking 
about  were  conditions  under  a  local  department  of  health. 

Mr.  Cooper.  I  do  not  believe  that  any  member  of  this  committee,  or  any  member 
of  the  Senate  committee  considering  this  measure,  or  those  in  favor  of  the  bill,  have 
any  such  idea  in  their  minds  at  all.  I  think  that  they  would  absolutely  oppose  it 
if  they  thought  so. 

Mrs.  Leatherbee.  That  is  the  reason  I  am  trying  to  call  it  to  the  attention  of  this 
committee.  We  are  asking  that  you  do  not  read  the  phraseology  of  the  bill,  but  not 
only  that  you  look  at  it  carefully  in  every  word  and  in  every  point  of  punctuation,  to 
see  what  the  possibilities  in  this  bill  are,  or  for  possibilities  that  might  occur  that  Mr. 
Towner  had  not  the  slightest  desire  or  intention  of  having  to  occur.  A  law  should  be  so 
carefully  drawn,  in  my  opinion — although  I  do  not  know  that  is  worth  anything — that 
anybody  can  understand  it  thoroughly  from  beginning  to  end  without  any  question 
of  what  might  happen. 

Mr.  Cooper.  Are  you  and  your  organization  ready  to  submit  an  amendment?  I 
think  that  Judge  Towner  and  the  comrdittee  would  welcome  any  suggestions  on  that 
line. 

Mrs.  Leatherbee.  Senator  Kenyon  gave  us  the  same  very  polite  invitation  before 
the  Senate  committee,  and  while  we  were  drawing  up  our  suggestions,  Senator 
Moses  offered  an  amendment,  and  we  support  the  Moses  amendment,  provided  the 
Federal  Government  is  to  do  anytliing  on  the  subject. 

Mr.  Mapes.  You  spoke  of  the  Moses  amendment:  Is  that  incorporated  in  the  report 
of  the  Senate  committee  or  is  it  in  the  Senate  bill? 

Mr.  Towner.  It  was  a  separate  bill. 

Mrs.  Leatherbee.  I  beg  your  pardon,  Mr.  Towner,  I  have  it  here.  It  is  an  amend- 
ment offered  by  Mr.  Moses  on  April  28,  1921,  on  the  very  day  on  which  I  was  testifying 
before  the  Senate  committee.  Therefore,  when  I  got  back,  this  amendment  had 
already  been  offered,  and  we  wrote  Mr.  Kenyon,  of  the  Senate  committee,  stating 
that  under  the  conditions,  if  the  Federal  Government  were  to  do  anything,  this  Moses 
amendment  embodied  our  views,  because  it  provides  for  hospitals  and  it  provides  for 
special  case. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  77 

Mr.  TowNBK.  This  was  not  before  the  Senate  committee  and  was  not  considered  as 
an  amendment,  but  it  was  introduced  indepench^nf ly  in  the  Senate  as  a  substitute 
for  this  bill,  was  it  not? 

Mrs.  Leathehbek.  I  will  leave  that  to  you,  ^^r.  To'Vvner,  because  I  do  not  know 
enough  to  say  about  that. 

Mr.  Towner.  We  want  to  get  at  what  was  done. 

Mrs.  Leathuhbke.  It  is  known  generally  as  the  Moses  amendment. 

Mr.  TowNEu.  It  was  offered  as  a  substitute  for  the  other  bill.  It  was  introduced 
independently,  and  was  not  before  the  Senate  committee  when  it  considered  the  bill. 

Mrs.  Leathehbee.  1  think  it  is  generally  and  popularly  known  as  the  Moses 
amendment.     I  think  that  is  right. 

Mr.  Sanders.  I  would  like  to  have  you  note  the  reading  of  this  amendment 

Mrs.  Leatherbee.  Which  amendment  is  that? 

Mr.  Sanders.  This  is  an  amendment  which  is  included  in  section  8  of  the  Senate 
bill  as  reported  by  the  Senate  committee.  This  proposed  amendment  to  the  Senate 
bill  reads  as  follows: 

"Provided,  That  no  plans  of  the  States  under  this  act  shall  provide  for  any  official 
or  agent  or  representative  entering  any  home  over  the  objection  of  the  parents,  or 
either  of  them,  or  the  person  standing  in  loco  parentis,  nor  shall  any  employees  of  the 
Children's  Bureau  by  virtue  of  this  act  have  any  right  to  enter  any  home  over  the 
objection  of  the  parents,  or  either  of  them,  or  the  person  standing  in  loco  parentis." 

Would  that  meet  the  objections  that  you  had  in  mind? 

Mrs.  Leatherbee.  I  think  not. 

Mr.  Sanders.  What  additional  objections  do  you  have  in  mind,  except  the  objec- 
tions that  that  amendment  meets? 

Mrs.  Leatherbee.  Do  you  mean  to  the  bill?  Our  objection  is  that  it  does  not 
provide  anything;  it  does  not  do  anytJiing  for  the  care  or  for  the  instruction  of  the 
prospective  mother  in  any  way,  shape  or  manner.  The  bill  provides  no  hospitals; 
it  provides  no  beds;  and  it  provides  no  niu'sing  care.  It  absolutely  provides  nothing 
for  the  object  which  it  is  presumed  to  have  in  mind. 

Mr.  Sanders.  I  am  not  talking  about  that,  but  I  mean  the  objection  you  have 
been  urging  that  it  would  interfere  with  the  family  or  with  the  home.  The  adoption 
of  that  amendment  I  have  read  would  obviate  that  objection,  would  it  not? 

Mrs.  Leatherbee.  To  a  certain  extent. 

Mr.  Sanders.  To  what  extent  would  it  not  do  so? 

Mrs.  Leatherbee.  I  suppose  if  anybody  came  to  the  door  with  a  club  demanding 
admission  and  the  people  would  not  let  them  in,  this  would  support  them  in  denying 
them  admission. 

Mr.  Sanders.  This  amendment  does  not  say  that,  does  it? 

Mrs.  Leatherbee.  It  says  here  "over  the  objection  of  the  parents,"  etc.  I  do 
not  suppose  they  could  force  their  way  into  the  home. 

Mr.  Sanders.  As  a  matter  of  fact,  mth  that  amendment,  there  certainly  could  be 
no  doubt  about  the  proposition  that  this  bill  does  not  provide  for  interference  in  any 
way  with  home  life. 

Mrs.  Leatherbee.  It  necessarily  does  interfere .    That  can  be  evaded. 

Mr.  Sanders.  How  can  it  be  an  interference? 

Mrs.  Leatherbee.  It  interferes  to  the  extent  that  the  Federal  Government  takes 
on  the  authority  to  give  advice  and  force  advice  upon  people . 

Mr.  Sanders.  What  proAision  is  there  in  this  bill  to  force  advice  upon  the  people? 

Mrs.  Leatherbee.  That  is  exactly  what  I  have  said  before.  The  provision  is  not 
there,  but  there  is  nothing  to  prevent  it,  unless  by  that  amendment. 

Mr.  Sanders.  There  is  nothing  in  the  bill  which  provides  it,  or  which  authorizes 
it,  or  which  justifies  it? 

Mrs.  Leatherbee.  It  might  justify  it,  but  it  does  not  authorize  it. 

Mr.  Sanders.  What  specific  provision  of  the  bill  justifies  it? 

Mrs.  Leatherbee.  It  does  not  authorize  it  specifically. 

Mr.  Sanders.  The  real  objection  that  you  have  is  with  regard  to  the  tendency  of 
the  legislation  rather  than  to  what  is  within  the  purview  of  the  bill? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Sanders.  Of  course  you  are  appearing  as  the  representative  of  the  Antisuffrage 
Association? 

Mrs.  Leatherbee.  Yes,  sir.  . 

Mr.  Sanders.  I  am  anxious  to  know  when  that  organization  took  action  with 
respect  to  the  Sheppard-Towner  bill. 

Mrs.  Leatherbee.  I  have  not  the  note  with  me,  but  I  think  it  was  at  an  executive 
meeting  some  time  in  the  spring.  I  do  not  remember  just  when.  I  think  it  was  in 
Januarj'  or  early  in  the  spring. 


78  PUBLIC   PROTECTION    OF   MATERISriTY   AND   INFANCY. 

Mr.  Sanders.  Have  they  taken  action  against  the  bill  introduced  for  a  similar 
purpose  by  Miss  Rankin? 

Mrs.  Leatherbee.  I  can  not  tell  you.    I  do  not  go  to  all  of  the  executive  meetings. 

Mr.  Sanders.  The  article  you  read  from  the  Boston  Transcript  in  regard  to  this 
bill  intimates  that  it  might  have  been  brought  about  by  virtue  of  the  action  of  the 
women  voters  after  the  suffrage  amendment  was  put  into  effect.     Is  that  your  opinion? 

Mrs.  Leatherbee.  Is  it  my  opinion  what? 

Mr.  Sanders.  That  the  action  of  the  women  voters  who  were  enfranchised  by  the 
Federal  suffrage  amendment  caused  this  legislation  to  be  proposed? 

Mrs.  Leatherbee.  I  do  not  know  whether  they  caused  it  to  be  proposed,  but  1 
know  that  they  support  it. 

Mr.  Sanders.  Of  course,  as  a  matter  of  fact,  the  legislation  was  proposed  by  Miss 
Rankin  in  Congress,  preceding  the  adoption  of  the  amendment. 

Mrs.  Leatherbee.  I  have  no  way  of  knowing  why  she  proposed  it  or  whether  it. 
was  done  upon  her  own  individual  initiative  or  at  the  request  of  some  organization . 
I  would  not  know  that. 

The  Chairman.  If  you  want  light  on  that,  do  you  object  to  my  reading  from  the 
statement  of  Miss  Lathrop  before  the  Senate  committee  in  answer  to  that  very  question?" 

Mr.  Sanders.  I  would  not  object. 

The  Chairman.  I  have  before  me  a  copy  of  the  hearings  before  the  Senate  Com- 
mittee on  Education  and  Labor  on  Senate  bill  1039.  In  the  course  of  the  proceedings 
the  chairman  asked  Miss  Lathrop  this  question: 

"Did  you  originate  this  bill?    Was  it  a  product  of  yours?" 

To  that  question  Miss  Lathrop  made  this  answer: 

"The  bureau  did;  and  I  wish  to  say  this,  that,  of  course,  the  bureau  is  not  in  a 
position  to  push  this  measure  or  to  secure  information  or  sanction  for  it,  nor  have  we 
endeavored  to  do  so.  I  have  been  astounded  at  the  amount  of  publicity  that  it  has 
received.     It  evidently  has  met  the  sense  of  a  need  long  existing." 

Mr.  Graham.  Whose  testimony  was  that? 

The  Chairman.  That  was  the  testimony  of  Misa  Lathrop,  the  head  of  the  Childreu  =■ 
Bureau. 

Mr.  SanOers.  That  does  not  change  the  fact  that  the  bill  was  introduced  by  Miss 
Rankin. 

The  Chairman.  Not  at  all,  but  that  is  a  part  of  the  history  of  it. 

Mr.  Sanders.  Did  the  antisuffrage  organizatioii  in  Massachusetts  go  on  record  as 
opposing  any  other  bill  at  the  time  it  opposed  this  bill? 

Mrs.  Leatherbee.  I  do  not  remember.     I  can  not  say. 

Mr.  Sanders.  Have  they  passed  resolutions  condemning  other  bills  in  Congress? 

Mrs.  Leatherbee.  They  went  on  record  very  strongly  and  unanimously  against 
the  Smith-Towner  bill,  but  I  do  not  think  it  was  at  the  same  meeting.  I  can  not, 
answer  as  to  that. 

Mr.  Sanders.  Did  they  go  on  record  against  the  Federal  child  labor  law? 

Mrs.  Leatherbee.  I  think  not. 

_Mr.  Sanders.  Did  they  go  on  record  against  any  other  welfare  legislation,  or  what 
might  be  termed  "welfare  legislation''? 

Mrs.  Leatherbee.  I  can  not  tell  you. 

Mr.  Hawes.  Mrs.  Leatherbee,  what  is  the  difference  between  National  and  State 
control.  In  Massachusetts  you  have  health  boards,  charity  boards,  and  other  local 
organizations  that  care  for  this  subject? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Hawes.  Andif  any  of  these  local  agencies  does  not  function  properly,  it  becomes 
unpopular,  and  at  the  end  of  their  term  of  office  the  people  of  Boston  will  have  an 
opportunity  to  dispense  with  their  services,  or  they  may  be  removed  from  office. 

Mrs.  Leatherbee.  Our  health  department  in  Boston  is  under  a  commissioner 
appointed  by  the  mayor. 

Mr.  Hawes.  He  can  be  removed  through  the  local  sentiment  of  Boston  as  expressed 
in  the  election  of  a  mayor? 

Mrs.  Leatherbee.  Yes,  sir.  If  the  local  sentiment  were  to  demand  it,  I  presume 
the  mayor  would  either  ask  for  his  resignation  or  else  discharge  him  or  dismiss  him. 

Mr.  Hawes.  So  that  the  Boston  institutions  are  controlled  by  the  majority  senti- 
ment of  the  people  of  Boston,  through  some  agency  of  the  Government? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Hawes.  And  that  is  true  of  any  State  health  agency? 

Mrs.  Leatherbee.  Yes,  sir.  We  also  have  a  public  health  department  for  the 
State.     Our  governor  appoints  the  commissioner. 

Mr.  Hawes.  You  draw  a  distinction  there,  and  I  understand  that  your  main  objec- 
tion to  this  bill  is  because  the  agencies  can  not  be  controlled  bv  the  local  communitv- 


PUBLIC   PROTECTTON   OF   MATERNITY   AND   INFANCY.  79 

or  the  Slate.  If  you  wanted  to  change  a  Federal  law,  you  would  have  to  conniilt  the 
citizens  of  Texas,  Ariz,ona,  New  Mexico,  Maine,  and  Washington,  and  all  of  the  48 
States  of  the  Union? 

Mrs.  Leathekbee.  Yes.  sir. 

Mr.  IIawes.  You  are  largely  in  favor  of  th"  objects  of  this  Inll? 

Mrs.  Leatheisbee.  We  are  in  favor  of  the  results  wnich  people  claim  this  >)ill  will 
effect.     Everybody  would  be  in  favor  of  that. 

Mr.  Hawes.  Bat  your  fundamental  ol)jection  is  that  it  can  not  be  controlled  by 
local  sentiment? 

Mrs.  Leatheijbee.  Yes,  sir. 

Mr.  Hawes.  That  is  a  fimdamental  objection? 

Mrs.  IjEAtherbee.  Yes,  sir;  that  is  one  of  the  objections. 

Mr.  Hawe.s.  You  were  asked  what  section  of  this  bill  gave  Federal  control  over  the 
State,  and  you  said  that  it  was  vague  and  indefinite  on  that  subject:  Have  you  read 
section  8? 

Mrs.  T.eatherbee.  Tnis  is  the  Hoase  bill  that  I  have. 

Mr.  Hawes.  Does  not  section  8  mean  that  the  national  bureau  could  provide  a  set 
of  rules,  regulations,  or  directions,  and  unless  the  State  complied  with  the  national 
rules  and  regulations,  they  would  receive  no  benefits,  or  receive  no  money  from  the 
National  Government? 

Mrs.  Leatherbee.  No,  sir;  but  they  would  have  to  pay  their  proportion  ji:^t  the 
same. 

Mr.  Hawes.  They  could  not  get  any  money? 

Mrs.  Leatherbee.  They  could  not  get  any;  no,  sir. 

Mr.  Hawes.  Unless  they  complied  with  the  rules  and  regulations  written  by  this 
department,  which  are  not  even  written  into  this  law. 

Mrs.  Leatherbee.  Yes,  sir;  exactly. 

Mr.  Hawes.  So  nobody  to-day  knows  what  those  regulations  are  to  be.  This  board 
is  to  be  created  and  then  this  board  will  write  the  regulations.  If  the  State  does  not 
comply  with  those  regulations,  they  mil  be  given  no  money. 

Mrs.  Leatherbee.  I  think  you  answered  that  question  yourself 

Mr.  Hawes  (interposing).  You  are  the  witness.     Is  that  a  correct  statement? 

Mrs.  Leatherbee.  Exactly;  yes,  sir. 

Mr.  Hawes.  So  that  there  is  nothing  in  this  bill  that  tells  you  how  far  the  Govern- 
ment may  go  in  its  regulations,  and  those  regulations  are  yet  to  be  written  by  people 
whose  names  are  unknown  to-day.  Unless  each  one  of  the  48  States  agrees  to  something 
that  an  unknown  board  has  not  yet  written,  it  can  not  get  a  dollar  under  this  bill — is 
that  yo.ir  ^dew? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Hawes.  ^^^len  Congress  makes  appropriations  for  Federal  aid  for  roads,  it 
provides  certain  specific  limitations  upon  the  use  of  Federal  money  by  the  State. 
Are  you  familiar  with  that? 

Mrs.  Leatherbee.  I  am  not;  no,  sir. 

Mr.  Hawes.  For  the  purpose  of  illustration,  under  the  Federal  road  aid  provision, 
the  State  matches  the  Federal  money,  and  the  United  States  Government,  in  addition, 
says  this  road  must  be  built  of  a  certain  kind  of  material,  or  a  certain  width,  and  must 
be  part  of  a  connected  system,  and  it  must  be  maintained.  This  bill  attempts  the 
same  thing,  but  what  it  intends  to  do  is  not  written  into  the  bill. 

Mrs.  Leatherbee.  No,  sir. 

Mr.  Hawes.  That  is  left  to  somebody  yet  to  be  appointed,  to  say  what  the  States 
must  do  before  they  can  secure  a.  dollar. 

Mrs.  Leatherbee.  That  is  my  opinion. 

Mr.  Cooper.  Is  it  not  a  fact  that  those  regulations  relative  to  good  roads,  or  national 
aid  for  roads,  are  not  in  the  law?     They  are  fixed  by  the  commission. 

Mr.  Hawes.  No,  sir;  they  are  in  the  law. 

Mr.  Cooper.  Such  as  the  specifications  as  to  how  wide  the  roads  shall  be? 

Mr.  Hawes.  No;  but  they  must  be  part  of  a  connected  system, "and  must  be  main- 
tained or  Federal  aid  may  be  withdrawn.  Now,  that  is  not  in  this  bill.  It  does  not 
even  provide  that  the  money  shall  be  withdrawn  if  the  State  does  not  do  certain  things. 

Mr.  Rayburn.  I  think  Mr.  Hawes  has  covered  most  of  the  things  that  I  wanted  to 
ask.  When  you  say  the  State,  do  you  distinguish  between  the  Federal  Government 
and  the  State  govermnent? 

Mrs.  Leatherbee.  I  do  there,  unless  it  is  specifically  mentioned.  When  I  say  the 
State,  I  mean  the  State  government. 

Mr.  Rayburn.  Then,  it  is  quite  a  different  matter  for  the  State  to  do  certain  things 
and  for  the  Federal  Government  to  undertake  to  do  the  same  things? 

Mrs.  Leatherbee.  Yes,  sir. 


80  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Mr.  Rayburn.  It  is  quite  a  different  matter. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Rayburn.  On  the  question  of  suffrage,  do  you  think  that,  fundamentally,  there 
is  quite  a  difference  between  the  Federal  Government  saying  who  shall  vote  in  the 
locality  or  the  local  government  saying  who  shall  vote  in  that  locality? 

Mrs.  Leatherbee.  I  certainly  do. 

Mr.  Reyburn.  So  do  I.     You  believe  in  compulsory  education,  do  you  not? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Rayburn.  So  do  I.  But  you  would  not  be  in  favor  of  the  Federal  Government 
passing  that  sort  of  law,  would  you? 

Mrs.  Leatherbee.  No,  sir. 

Mr.  Hawes.  I  gather  from  all  you  have  said,  that  your  objection  to  this  bill  is  be- 
cause there  is  an  undefined  power  placed  in  a  commission. 

Mrs.  Leatherbee.  Yes,  sir;  that  is  true. 

Mr.  Hawes.  That  is  first,  and  then  the  giving  of  national  control  over  matters  that 
have  heretofore  been  controlled  exclusively  by  the  State? 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Hawes.  But  you  are  not  opposed  to  the  general  objects? 

Mrs.  Leatherbee.  Nobody  could  be  opposed  to  anything  that  would  save  maternal 
and  infant  lives. 

Mr.  Hawes.  If  this  bill  could  be  properly  amended  to  meet  those  objections,  your 
association  would  withdraw  its  objection? 

Mrs.  Leatherbee.  Our  association  could  never  withdraw  its  objections  to  any 
interference  with  State  rights  and  local  self-government. 

Mr.  Hawes.  But  if  it  were  to  be  amended  so  there  would  be  no  such  kn  interference? 

Mrs.  Leatherbee.  How  could  it  be? 

Mr.  Hawes.  It  could  be  amended  so  that  the  United  States  Government  could 
furnish  statistics,  general  information,  and  instructors  for  the  local  agencies,  and  the 
local  agencies  could  then  come  under  the  direction  of  the  State  control  board. 

Mrs.  Leatherbee.  They  are  doing  that  now.  The  Public  Health  Service  is  send- 
ing out  circulars. 

Mr.  Hawes.  You  have  no  objection  to  that? 

Mrs.  Leatherbee.  None  at  all.  That  is  a  very  helpful  service  that  the  Public 
Health  Service  is  rendering  in  sending  out  those  circulars,  because  the  circulars  that 
the  Public  Health  Service  is  getting  out  have  nothing  in  them  except  medical  matters. 
They  are  professional  papers  written  by  men  of  professional  education,  and  they  carry 
no  propoganda  of  any  kind  whatever.     They  are  p'ain  itatements. 

Mr.  Hawes.  You  understand,  of  course,  that  if  the  United  States  Government 
takes  statistics  in  Arkansas  and  Massachusetts,  and  compares  the  two,  and  then 
sends  that  comparison  to  the  State  of  Missomi,  it  is  valuable  to  the  people  of  Missouri. 

Mrs.  Leatherbee.  I  do  not  know;  I  presume  so,  but  the  United  States  Census 
does  that. 

Mr.  Hawes.  On  the  whole  question  of  hygiene,  and  matters  relating  to  this  sub 
ject,  if  the  information  were  properly  disseminated  to  the  State  agencies,  even  if 
it  were  accompanied  by  lecturers  and  instructors,  there  could  be  no  objection  to  that? 

Mrs.  Leatherbee.  No,  sir;  not  if  those  lecturers  were  professional  men.  Without 
speaking  for  my  association  on  that,  I  personally  would  say  that  the  work  now  being 
done  by  the  Public  Health  SerAdce  in  regard  to  bubonic  plague,  and  in  sending  out 
experts  to  give  advice  to  chambers  of  commerce,  and  that  sort  of  thing,  is  something 
which  everybody  should  commend;  and  if  the  Federal  Government  will  restrain 
itself  to  the  dissemination  of  statistics  gathered  through  the  Census  Bureau  in  regard 
to  maternity  matters,  infant  hygiene,  etc.,  and  if  the  Public  Health  Service  will 
send  out  its  circulars  in  regard  to  prenatal  care,  etc.,  that  would  be  considered 
advisable. 

Mr.  Hawes.  Do  you  think  that  the  Children's  Bureau  is  doing  excellent  work 

Mrs.  Leatherbee.  Do  you  ask  my  personal  opinion? 

Mr.  Hawes.  Yes,  madam. 

Mrs.  Leatherbee.  I  would  rather  not  answer. 

Mr.  Hawes.  Theirs  is  now  a  work  of  instruction? 

Mrs.  Leatherbee.  I  presume  so. 

Mr.  Sanders.  Mr.  Hawes  asked  you  something  about  the  plans  for  carrying  on 
this  work.  You  think  that  those  plans  should  be  made  by  the  different  State  organi 
zations,  do  you  not? 

Mrs.  Leatherbee.  I  do  not  exactly  understand  that. 

Mr.  Sanders.  You  think  that  the  plans  for  carrying  out  this  work  could  be  mad 
by  the  different  State  organizations? 

Mrs.  Leatherbee.  I  think  they  could  be  prepared  by  the  local  organizations  i] 
the  cities  and  towns. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  81 

Mr.  Sanders.  Do  you  think  it  is  an  unreasonable  provision,  when  the  Federal 
Government  is  appropriating  money,  to  provide,  as  it  does  in  this  bill,  that  these 
plans  shall  be  in  conformity  with  the  provisions  of  this  law,  and  reasonably  appro- 

f>riate  and  adequate  to  carry  out  its  purposes?    Do  you  think  that  is  an  unreasonable 
imitation? 

Mrs.  Leatherbee.  I  do  not  know  what  that  phrase,  "reasonably  appropriate  and 
adequate  to  carry  out  its  purposes,"  means.     There  is  no  standard  provided  here. 

Mr.  Sanders.  Don't  you  think  that  the  Federal  Government  should  stand  by  and 
allow  these  local  organizations  to  decide  on  the  plans,  and,  if  the  plans  be  appropriate 
and  adequate,  approve  them? 

Mrs.  Leatherbee.  I  think  the  Federal  Government  should  leave  the  local  com- 
munity to  run  this  business  itself.  The  different  health  commissioners  and  different 
health  departments  have  meetings  at  various  times,  and  they  consult  one  "with  another. 
They  tell  what  is  being  done  in  one  city  in  another,  and  it  is  to  be  supposed  that  if 
a  plan  works  successfully  in  one  city,  it  will  be  adopted  by  another  city  where  the 
conditions  are  similar. 

Mr.  Sanders.  According  to  your  opinion,  do  you  think  it  would  be  better  to  pro- 
vide in  the  law  what  the  plans  shall  be  in  the  various  States? 

Mrs.  Leatherbee.  I  think  it  would  be  better  not  to  have  any  law  at  all  on  that 
subject. 

Mr.  Sanders.  But  if  we  do  have  a  law,  do  you  think  it  would  be  preferable  to 
leave  the  plans  to  the  States,  rather  than  have  the  plans  made  in  the  law? 

Mrs.  Leatherbee.  I  think,  if  it  is  necessary  to  have  any  law,  that  all  the  power 
possible  should  be  .sjiven  to  the  local  authorities. 

Mr.  Lea.  If  the  Federal  Government  appropriates  large  sums  of  money  for  carrying 
on  this  work,  then  will  it  not  logically  follow  that  the  Federal  Government  should 
exercise  a  large  degree  of  control  over  the  expenditure  of  its  own  money? 

Mrs.  Leatherbee.  Well,  of  course  the  Federal  Government's  money  comes  from 
the  States. 

Mr.  Lea.  It  comes  from  the  Federal  Treasury. 

Mrs.  Leatherbee.  Yes,  sir. 

Mr.  Lea.  Congress  will  be  responsible  for  its  expenditure,  and,  in  providing  it, 
do  you  not  think  that  it  is  the  duty  of  the  Federal  Government  to  exercise  a  large 
degree  of  control  over  its  expenditure? 
,    Mrs.  Leatherbee.  If  the  law  appropriates  money  for  a  specific  purpose;  yes,  sir. 

Mr.  Lea.  As  I  understand  you,  in  speaking  of  the  things  that  do  not  appear  in  the 
bill  you  have  in  mind  the  practical  operation  of  this  law  through  the  years  to  come? 

Mrs.  Leatherbee.  Yes. 

Mr.  Lea.  The  demands  to  be  made  upon  the  Federal  Treasury  and  the  logical 
demands  that  will  be  made  upon  the  Federal  Treasiuy  through  Federal  control. 

Mrs.  Leatherbee.  More  and  more  appropriations  constantly. 

Mr.  Lea.  If  the  Federal  Government  should  largely  support  this  effort  in  the  future, 
it  should  largely  control  it;  does  not  that  follow? 

Mrs.  Leatherbee.  Naturally. 

Mr.  Lea.  And  that  is  largely  what  you  regard  as  the  vice  of  this  law;  that  is,  it 
ultimately  calls  for  Federal  control  if  we  are  going  to  have  Federal  support? 

Mrs.  Leatherbee.  Yes,  sir. 

(The  committee  thereupon  adjourned  until  Monday,  July  18, 1921,  at  9  o'clock  a.  m.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Monday,  July  18,  1921. 
The  committee  met  at  9  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

The  Chairman.  Gentlemen  of  the  committee,  if  you  will  kindly  come  to  order  we 
will  proceed  with  the  further  consideration  of  H.  fe.  2366.  The  chair  will  ask  Dr. 
Humiston,  of  Chicago,  to  appear  before  the  committee. 

STATEMENT  OF  DR.  CHARLES  E.  HUMISTON,  PRESIDENT  OF  THE 
ILLINOIS  STATE  MEDICAL  SOCIETY,  CHICAGO,  ILL. 

The  Chairman.  Doctor,  will  you  kindly  give  your  name,  your  residence,  and  any 
-representation  which  you  may  have,  and  then  proceed  in  your  own  way?  Will  you 
care  to  be  interrogated  as  you  go  along? 

7465'!— 21 6 


82  PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY. 

Dr.  HuMiSTON.  Mr.  Chairman  and  members  of  the  committee,  my  name  is  Charles 
E.  Himiiston;  my  home  is  Chicago,  111.  I  am  the  president  of  the  Illinois  State 
Medical  Society,  and  I  appear  before  your  committee  in  my  official  capacity  repre- 
senting the  wishes  and  the  declared  attitude  of  the  State  society,  and,  likewise,  I  come 
as  a  citizen  of  Illinois  to  convey  to  you  the  attitude  of  the  people  of  that  Commonwealth 
on  this  particular  bill.  I  am  also  authorized  to  represent  the  Civic  Federation  of 
Chicago.  I  trust  I  may  be  pardoned  if  I  confine  my  remarks,  or  endeavor  to,  to  the 
bill  now  under  consideration.  I  wish  to  say  in  the  beginning  that  the  title  of  this  bill 
meets  the  hearty  approval  of  every  right-thinking  person.  We  have  no  quarrel  with 
the  object  of  this  bill,  but  we  do  have  with  the  method  which  it  sets  up. 

I  do  not  know  to  what  extent  I  may  be  permitted  to  encroach  upon  your  time.  I 
desire  to  be  brief  and  shall  attempt  to  be  so,  and  I  woitld  like  to  be  interrogated  not 
here  and  there  through  the  few  remarks  I  shall  attempt  to  make,  but  rather  when  I 
have,  in  a  measure,  finished  what  I  wish  to  present,  if  that  is  agreeable. 

The  Chairman.  Quite  so. 

Dr.  HxjMisTON.  Finst  of  all,  as  to  the  people  of  Illinois  represented  in  the  general 
assembly.  The  legislature  which  has  jUst  adjourned  had  introduced  therein  a  number 
of  bills — three,  I  believe,  at  least,  having  a  direct  bearing  on  this  so-called  Sheppard- 
Towner  bill  and  the  legislature  rejected  them.  I  know  of  no  way,  aside  from  a  referen- 
dum, of  getting  at  the  sentiment  of  the  people  better  than  through  the  acts  of  their 
accredited  representatives.  The  Illinois  State  Medical  Society,  of  which  I  have  the 
honor  to  be  the  president  and  chairman  of  its  legislative  committee,  has  time  and  again 
taken  action  on  matters  of  this  kind,  and  definite  action  on  this  particular  bill,  in  that 
it  antagonized  it  in  the  legislature  of  our  State. 

Now,  the  reason  of  this — and  I  do  not  wish  to  be  misunderstood  or  cross-examined 
with  the  idea  in  view  that  the  medical  profession  in  any  way  antagonizes  the  purpose; 
it  is  this  bill  which  we  wish  to  meet.  There  are  a  number  of  very  definite  reasons 
why  the  Illinois  State  Medical  Society,  comprising  more  than  7,000  members,  is 
opposed  to  the  terms  of  this  bill.  One  of  them  is  because  it  uses  the  practice  of  medi- 
cine as  a  doorway  for  the  central  government  to  invade  the  police  power  of  the  States 
under  which  the  medical  practice  acts  of  all  States  are  had  and  operate.  This  bill 
interferes  with  the  practice  of  medicine  for  this  reason:  It  appropriates  money  for  the 
instruction  of  the  people  of  the  various  States  in  hygiene,  in  maternity  and  the  welfare 
of  babies.  That  of  itself  is  doing  indirectly  what  our  form  of  Government  forbids  to 
be  done  directly,  supervising  the  practice  of  medicine,  which  is  delegated,  or  really 
belongs,  to  the  States.  It  does  it  in  this  way:  The  money  which,  of  course,  is  collected 
from  the  States,  as  we  have  no  other  way  of  getting  money  in  this  country  except  by 
taxation,  and  the  people  pay  it,  the  money  which  is  available  and  the  funds  which 
are  to  be  had  under  this  law  can  not  otherwise  be  had  by  the  different  States  until 
the  proper  body  in  the  State  complies  with  the  terms  laid  down  by  the  Children's 
Bureau  in  the  Department  of  Labor. 

Now,  that  practically  says  to  Illinois,  "If  you  wish  any  of  this  money  to  spend, 
make  your  terms  to  suit  us.  If  the  terms  do  not  suit,  you  can  not  have  it. "  The  argu- 
ment IS  advanced,  if  you  do  not  want  it  do  not  take  it.  That  I  would  not  object  tc 
if  it  would  also  say,  "If  you  do  not  want  this  money,  you  need  not  pay  any  taxes  int<: 
this  fund."  We  can  not  help  being  taxed — and  I  wish  to  say  right  here,  in  passing 
that  fiu'ther  taxation  is  perilous  to  the  condition  of  things  in  this  country.  I  trave' 
somewhat  widely  and  meet  many  people,  and  I  find  that  the  attitude  of  the  public 
is  sullen,  resentful,  and  suspicious.  The  people  feel  that  they  are  being  overtaxed 
that  their  money  has  been  wasted,  and  they  resent  anything  that  looks  like  mor( 
taxes  at  this  particular  time.  That  is  an  observation  which  I  have'made  and  which 
I  dare  say,  you  will  not  dispute,  and  which,  in  a  measure,  I  feel  personally. 

The  activities  contemplated  by  this  bill  I  believe  to  be  95  per  cent  medical.  Th 
economic  and  the  other  sides  which  have  been  emphasized  are  entirely  secondar 
and  obscure.  The  mother  and  the  prospective  mother  with  her  new  babe  need  thi 
best  scientific  instruction,  not  merely  nontechnical  instruction.  I  do  not  mean  t 
say  they  need  not  have  nontechnical  instruction,  but  the  kind  of  instruction  tha 
those  mothers  need  is  of  the  highest  order,  technical,  and  where  would  you  look  for 
that  except  among  those  who  have  dedicated  their  lives  to  acquiring  and  giving  tha 
kind  of  instruction? 

I  would  say  that  from  the  testimony  given — and  I  have  just  gone  through  abou| 
80,000  words  of  testimony,  and  I  am  glad  it  is  called  testimony  instead  of  evidence- 
presented  before  a  committee  in  the  Senate,  and  very  little  of  it  has  a  direct  bearin 
on  the  terms  of  this  bill  and  its  application ;  but  that  testimony  presented  which  on  th 
face  of  it  appears  to  be  most  nearly  convincing  consists  of  statistics  from  the  healt  ' 
department  of  New  York  City.  The  representative,  an  employee  of  that  departmen  |i.j 
made  effective  use  of  the  showing  made  by  the  health  department  and  by  the  publi 


:  L. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  83 

health  nurses.  The  credit  is  due,  of  coiu-se.  somewhere;  but  it  is  not  due  to  such  a 
great  extent,  or  to  any  preat  extent,  to  the  heaUh  department  or  to  tlie  unrses,  as  such 
but  to  the  medical  profession,  which  has  du.?  out  and  developed  this  knowledtje. 
The  department  of  heallli  and  the  nurses  applied  the  knowledge  which  they  gained 
there. 

The  oldest  baby  welfare  center  in  the  world  is  in  a  country  for  which  our  young  men 
made  the  supreme  sacrilice.  Twenty-six  or  27  years  ago  it  was  established,  and  it 
still  exists,  or  others  hke  it,  in  that  country  which  we  all  love  and  are  willing' to  lieht 
for,  and  have  been  lighting  for,  a  country  in  which  the  people  are  past  masters  of  the 
ganie  of  avoiding  parenthood  and  where  the  death  rate  exceeds  the  birth  rate,  where 
this  baby  welfare  station  has  existed  for  27  years.  In  that  country  where  the  first 
one  was  established,  they  have  a  death  rate  of  babies  of  140,  almost  douljle  that  of  a 
city  in  this  country  comj)arable  in  size.  Now,  I  am  not  going  to  charge  that  welfare 
center,  nor  that  instruction,  nor  the  public  health  nurses,  nor  the  doctors  connected 
with  It  with  the  responsibility  for  the  loss  of  babies  in  that  country  or  for  the  avoid- 
ance of  motherhood,  as  has  been  suggested  before  this  committee,  or  at  least  before  the 
Senate  committee.  I  have  as  much  right,  however,  to  charge  those  results  which 
follow  as  the  heath  department  of  New  York  City  has  to  claim  so  great  a  degi'ee  of 
credit  for  their  activities;  but  I  would  be  just  as  unfair,  and  I  do  not  mean  intention- 
ally unfair  on  the  part  of  these  representatives  of  the  different  interests  and  munici- 
palities. I  charge  no  unfairness  and  detect  none  anywhere,  but  I  believe  there  is  a 
prejudice.  I  apply  the  simple  rules  of  eAidence.  I  believe  it  is  prejudice  and  can 
not  fairly  be  attributed  to  the  niu-ses  nor  to  the  teachings. 

This  is  a  medical  question,  and  it  is  super\dsing  the  practice  of  medicine  in  the 
different  States  through  a  Children's  Bureau  in  the  Department  of  Labor,  that  this 
bill  provides.  That  is  why  we  object  to  it.  We  object  to  this— and  when  I  say  '  ■  we  " 
I  mean  the  doctors  of  Illinois,  and  I  might  just  as  well  sav  the  doctors  of  the  American 
Medical  Association  in  this  wider  sense,  because  at  their  meeting  in  New  Orleans  a 
year  ago  a  resolution  was  passed  by  the  house  of  delegates  condemning  every  form  of 
State  medicine.  Direct  action  on  this  particular  bill  has  not  been  taken,  I  regret  to 
say.  I  regret  to  say  that  a  chance  was  not  afforded  at  the  Boston  meeting.  It  was  a 
serious  oversight  on  my  part  as  a  member  of  the  house  of  delegates  that  I  did  not- 
introduce  a  resolution  against  it,  but  if  I  live  until  the  meeting  in  St.  Louis  in  1922, 
and  if  there  is  any  use,  and  I  think  there  will  be,  of  introducing  such  a  resolution,  it 
■will  be  there  for  action  next  year  by  the  American  Medical  Association. 

Now,  we  object  to  placing  the  practice  of  medicine  or  any  part  of  it  under  the 
super\T.sion  of  a  lay  board.  We  object  to  any  form  of  State  medicine,  whether  it  is 
this  or  any  other,  and  that  answers  the  question  you  might  ask,  if  we  amend  it  thus 
and  so.  We  are  opposed  to  this  bill,  root  and  branch.  It  is  wrong  in  principle. 
The  Central  Government  has  no  proper  acti\dty  in  this  field.  We  object  to  this 
excursion  into  socialism.  It  is  not  only  ad\dce  "with  reference  to  hygiene  that  this 
question  covers;  that  is,  the  question  of  the  mortality  of  mothers  and  their  babies. 
It  is  as  much  a  question  also  of  food  and  raiment.  The  bills  from  foreign  countries 
referred  to  and  quoted  provide  something  very  similar  to  that:  I  take  i't  this  is  the 
opening  wedge  for  the  same  kind  of  benefit  in  this  country.  While  the  amount  of 
money  here  may  not  seem  large  it  is  small  for  the  purpose^  too  small  to  accomplish 
the  object,  but  it  is  a  beginning.  It  will  never  be  smaller.  If  it  were  brought  up 
to  the  ideals  of  the  sponsors  of  this  bill  it  would  be  §1,000,000,000  or  more  instead  of 
n,480,000. 

^  A  doctor  in  Illinois  is  not  able  to  practice  in  Indiana  unless  he  is  licensed  by  that 
State;  neither  can  he  go  into  Virginia  until  Virginia  bestows  upon  him  the  right  to 
follow  his  lifework.  I  think  we  have  a  right  to  complain  of  that,  but  under  our  form 
of  government  it  must  be  so.  The  doctors  are  licensed  by  the  several  States.  The 
General  Government  can  not  license  a  doctor  to  practice  in  the  other  States. 
Statistics  have  been  quoted  more  or  less  effectively.     The  fact  is  that  this  case  rests 

I  upon  the  shomng  made  by  such  statistics.     I  wish"  to  take  issue  with  the  statistics. 

,The  statements  made  by  the  proponents  of  this  bill  are  unjustified.     We  have  not 

I  statistics  that  are  reliable  to  base  any  such  positive  statements  upon,  and  to  show 
liow  they  vary,  when  this  bill  was  written  the  mortality  of  babies  was  100,  but  before 
the  sponsors  of  the  bill  could  get  to  it  somebody  else  foiind  that  the  same  authoritv — 
the  census— shows  only  87.  Reliable  statistics  can  not  be  had.  They  ought  to"  be 
ivailable.     Our  birth  registration  areas  should  be  developed.     This  might  help  some. 

J I  would  not  object  to  that  effect,  but  the  side  effects  which  should  be  taken  care  of  by 
the  States  and  which  are  being  taken  care  of  by  the  States  vary  much  overshadow  that 
me  effect.  Fortv-five  of  the  States  have  passed  enabling  liegislation  for  better  birth 
•egistration.  It  is  being  taken  care  of  by  the  States,  and  it  should  be,  and  the  medical 
profession  asks  that  you  contribute  your  decision  to  seeing  that  it  continues  to  be 


84  PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY. 

taken  care  of  there.  We  ask  the  committee  to  hand  this  question  back  to  its  proper 
parents,  the  States;  this  baby  question,  which  we  love  better  than  almost  everything 
else  in  the  wide,  wide  world,  we  wish  properly  taken  care  of.  The  admonition  may 
be  given  to  the  States  to  take  care  of  it  better  than  it  has  been  done.  It  is  closer  to 
our  hearts  than  almost  anything  else,  but  we  do  believe  that  this  bill  will  not  go  very 
far  toward  accomplishing  the  objects  for  which  it  is  designed. 

I  could  go  on  into  det?^ils  further  as  to  why  the  doctors  object,  and  show  that  visiting 
nurses  responsible  to  authorities  other  than  the  doctors  in  attendance  may  and  do 
cause  friction,  but  as  a  physician,  and  I  claim  to  be  one  of  the  kind  that  carries  a  grip, 
and  to  represent  the  rank  and  file  of  the  medical  profession,  I  come  here  to  antagonize 
the  views  of  some  doctors  from  health  departments  whose  compensation  is  money 
raised  by  taxes  and  whose  work  is  within  narrow  limits.  They  are  honest,  but  they  are 
prejudiced.  I  do  not  blame  them  for  wanting  more  money,  and  the  health  depart- 
ments of  the  various  States,  where  they  have  very  little  money,  would  like  to  see 
something  more  gotten  probably  from  the  Central  Government;  but  States  like  Illi- 
nois, that  pay  more  in  taxes  than  they  ever  get  back,  have  the  right,  on  the  same  basis, 
to  object. 

The  nurses  would  work  under  a  lay  director  responsible  to  the  bureau  in  the  Labor  |ii 
Department  here;  indirectly  responsible,  but  nevertheless  responsible.  Give  me  the 
power  to  say  to  the  department  of  health  at  Springfield,  through  its  children's  depart- 
ment, "Make  your  regulations  suit  me  or  you  get  no  money."  I  would  inspect  the 
regulations  and  would  say,  "Change  this,"  and  if  it  was  not  changed,  no  money  would 
be  forthcoming.  It  gives  to  the  Children's  Bureau  absolute  power  over  the  health 
departments  of  the  States.  As  a  principle  of  law,  you  have  no  right  to  do  by  indirect 
means  the  very  thing  which  is  forbidden  to  be  done  by  direct  measures. 

This  is  not  a  prepared  speech.  I  have  omitted  many  things  that  I  could  talk  about, 
but  I  realize  what  you  have  had  to  listen  to,  gentlemen;  I  realize  that  this  is  the  most 
widespread  and  popular  lobby  that  probably  has  ever  visited  this  city.  Every  em- 
ployee about  the  Government  buildings  of  whom  I  made  inquiry  where  I  might  go  to 
find  this  committee,  when  I  mentioned  the  magic  words  "maternity,"  said,  "Oh, 
maternity,"  and  knew  right  away  where  to  send  me.  It  is  talked  about  everywhere. 
"  I  agree  with  the  sentiment  that  makes  people  talk  about  it,  but  I  ask  you,  gentlemen, 
in  the  name  of  the  people  of  this  tax-ridden,  groaning  population,  not  to  saddle  anyfcut 
taxation  further  upon  the  people  at  this  particular  time,  and,  certainly,  do  not  do  it  ' 
under  a  bill  of  questionable  value  and  one  which  those  in  position  to  know  the  most 
about  it  are  opposed  to;  and  95  per  cent  of  the  doctors  of  this  country,  I  believe,  as  a 
fair  estimate,  are  opposed  to  it. 

Mr.  Sanders.  Doctor,  as  a  matter  of  fact,  the  American  Medical  Association,  after 
considering  various  resolutions  that  were  introduced,  finally  came  to  this  resolution, 
did  they  not: 

"Resolved  by  the  House  of  Delegates  of  the  American  Medical  Association,  That  it 
approves  and  indorses  all  proper  activities  and  policies  of  the  State  and  Federal  Gov 
ernments  directed  to  the  prevention  of  disease  and  the  preservation  of  the  public 
health." 

Dr.  HuMiSTON.  It  did.  It  adopted  that  very  thing  at  Boston.  Dr.  M.  L.  Harris 
of  Chicago,  worded  that  resolution,  and  the  question  was  asked.  Why  not  have  that 
in  the  negative  and  say  that  we  do  not  indorse  anything  except  those  activities  strictly 
covering  the  general  purposes  of  hygiene,  sanitation,  etc.,  such  as  the  prevention  o1 
yellow  fever  and  the  great  accomplishments  which  this  country  through  its  Depart 
ment  of  Public  Health  and  the  Surgeons  General  of  the  Army  and  the  Navy  have 
accomplished,  but  Dr.  Harris  said,  "I  prefer  to  state  a  thing  in  the  affirmative  rathei 
than  the  negative,"  and  that  is  why  it  stands  in  that  way.  I  was  there  and  helpec  "ij 
to  pass  that  resolution.  It  was  in  response  to  resolutions  from  five  States,  Illinois 
Michigan,  New  Hampshire,  Massachusetts,  and  New  York,  in  which  the  terms  usee 
varied  very  little,  all  denouncing  every  form  of  governmental  activity  either  bj 
subsidizing  health  centers  or  anything  like  it.  It  was  aimed  to  put  the  differen' 
States  on  record  against  any  form  of  health  insurance  or  compulsory  health  insurance 
or  health  centers  subsidized  by  the  State  or  National  Governments,  and  it  certain! 
included  things  like  this. 

Mr.  Sanders.  As  a  matter  of  fact,  the  resolution  does  not  condemn  anything  j 
does  it?     It  approves  and  indorses  activities  and  policies,  amongst  others,  of  th'Jj- 
Federal  Government,  directed  to  the  preservation  of  the  public  health,  and  also 
in  the  same  resolution,  the  prevention  of  disease,  so  that  it  goes  not  only  to  the  pre 
vention  of  disease  but  the  preservation  of  the  public  health. 

Dr.  HuMiSTON.  That  we  indorse,  but  1  claim  this  bill  is  outside  of  ■v\hat  that  resolu 
tion  comprehends.  I  helped  to  pass  that  resolution  and  I  know  what  it  meani 
and  I  know  what  the  house  of  delegates  meant  when  they  passed  it.     It  was  a  com 


im 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  85 

jromise  trying  to  cover  the  ground  and  to  get  something  of  that  kind  through.  It 
lid  not  contemplate  this  or  anything  like  it.     It  is,  however,  very  indefinite. 

Mr.  Sanders.  This  is  what  1  find  in  the  official  news  organ  of  that  body.  I  am 
[oing  to  skip  part  of  it  and  read  only  the  part  that  refers  to  tliis: 

"The  committee  has  very  carefully  coneddered  the  various  resolutions,  etc.,  has 
,iven  free  hearing  and  careful  attention  to  those  interests,  and  has  carefully  considered 
he  same  and  begs  to  report  as  a  substitute  for  all  resohitions  the  following,"  and  then 
ollows  the  resolution  which  I  just  read,  which  is  not  a  condemnation  of  any  activity 
)f  the  Federal  Government,  but  is  a  specific  indorsement  of  the  activities  and  policies 
lirected  tovv'ard  the  preservation  of  public  health,  and  this  was  in  June  of  1921. 

Dr.  HuMiSTON.  I  know;  1  was  there  and  I  am  willing  to  admit  it  was  a  sort  of  straddle 
;etting  out  of  a  very  embarrassing  situation,  because  there  were  members  there, 
epresentatives  of  the  health  departments  of  several  States,  whose  names  I  need  not 
nention,  who  were  on  these  committees  and  who  were  in  favor  of  these  things,  and 
here  was  more  or  less  of  a  compromise,  but  if  you  wish  to  introduce  that  at  all,  there 
s  an  editorial  in  these  records  from  the  Journal  showing  the  policy  of  the  Joui'nal. 
^lease  go  back  another  year  to  New  Orleans  where  every  form  of  State  medicine  is 
inqualifiedly  condemned,  and  this  I  claim  to  be  one  form  of  it. 

^ir.  Sanders.  As  a  matter  of  fact,  at  the  New  Orleans  meeting,  about  a  year  ago, 
liey  undertook  to  pass  a  resolution  condemning  this  bill  and  the  resolution  was  not 
)aesed :  is  not  that  a  fact? 

Dr.  HuMiSTON.  I  have  not  heard  of  any  such  resolution.  The  one  I  am  speaking  of 
lid  pass.  Unfortunately,  I  was  flat  on  my  back  in  bed  and  was  not  able  to  be  there 
nd  I  can  not  give  you  first-hand  information,  but  I  know  they  did  pass  the  one  I 
efcr  to. 

Mr.  Johnson.  Mr.  Sanders,  what  were  you  reading  from? 

Mr.  Sanders.  I  was  reading  from  the  Journal  of  the  American  Medical  Association, 

report  of  the  meeting 

Dr.  HuMiSTON  (interposing).  Of  the  house  of  delegates  at  Boston  in  June,  just 
assed? 

Mr.  Sanders.  In  June,  1921. 

Dr.  HuMiSTON.  I  would  like,  if  they  are  not  in  the  record,  to  have  those  editorials 
•ut  in.    There  are  two  of  them  in  the  Journal  showing  the  policy  of  this  organization. 

will  not  say  who  wrote  them,  but  they  are  from  the  editorial  department. 

The  Chairman.  Do  you  wish  to  enter  those  editorials  as  a  part  of  your  testimony? 

Dr.  HuMisTON.  Yes.    There  are  two  editorials. 

The  Chairman.  Can  you  identify  them? 

Dr.  HuMiSTON.  They  are  not  in  that  particular  Journal.  I  would  like  to  look  up 
tie  files  of  the  Journal  and  get  the  citations. 

The  Chairman.  Can  you  furnish  them  to  the  committee? 

Dr.  HuMisTON.  I  can  do  that;  yes,  sir.    Here  is  one  of  them. 

The  Chairman.  Will  you  read  it? 

Dr.  HuMiSTON.  I  will  leave  it  with  the  committee.  It  is  already  in  the  record  of 
our  Senate  committee  proceedings. 

(The  matter  referred  to  is  as  follows:) 

"federal  care   of  maternity  and  infancy — THE   SHEPPARD-TOWNER   BILL. 

"As  announced  in  a  recent  issue,  the  Sheppard-Towner  bill,  providing  for  the 
public  protection  of  maternity  and  infancy,'  passed  the  Senate  December  16.  In 
le  House  it  was  refeiTed  to  "the  Committee  on  Interstate  and  Foreign  Commerce, 
'hich  on  January  25  reported  it  out  mtn  several  amendments.  The  l:)ill,  as  it  now 
;ands,  appropriates  $1,480,000  annually  for  'promoting  the  care  of  maternity  and 
ifancy  in  the  several  States;  to  provide  instruction  in  the  hygiene  of  maternity  and 
ifancy;'  and  for  'making  such  studies,  investigations,  and  reports  as  will  further  the 
Bicient  administration  of  the  act.'  It  authorizes  the  Children's  Bureau  to  form  an 
ivisory  committee  consisting  of  the  Secretary  of  Agriculture,  the  Surgeon  General  of 
le  Public  Health  Service,  and  the  Commissioner  of  Education.  The  bureau  is 
athorized  to  expend  5  per  cent  of  the  appropriation  for  administration  purposes,  to 
ay  $10,000  annually  to  each  State  for  administration  expenses,  and  to  apportion  the 
;mainder  to  the  States  in  proportion  to  their  population,  pro"vided  each  State  appro- 
riates  an  amount  equal  to  the  amount  it  receives.  In  any  State  having  a  child 
elfare  or  child  hygiene  division  in  its  State  health  agency,  the  State  health  authori- 
es  shall  administer  the  act.  The  State  health  authorities  shall  submit  to  the 
hildren's  Bureau  a  detailed  plan  for  administration  and  'for  instruction  in  the 
ygiene  of  maternity  and  infancy  through  public  health  centers,  consultation  centers, 
id  other  suitable  methods.' 


86  PUBLIC   PROTECTION"    OP   MATERls^ITY  AND   INFANCY. 

"All  will  agree  that  the  objects  sought,  namely,  the  care  of  maternity  and  infancy, 
and  instruction  in  the  hygiene  of  maternity  and  infancy,  are  in  the  highest  degree 
commendable.  There  can  not  be  too  much  knowledge  or  too  much  instruction  of  the 
right  sort  on  such  \dtal  subjects.  There  are,  however,  serious  objections  to  the  methods 
proposed. 

' '  The  bill  provides  funds  through  the  apparently  popular  method  of  Federal  State 
aid,  i.  e.,  the  approporation  of  a  large  sum  of  money  from  the  Federal  Treasury  to  be 
prorated  to  the  various  States,  provided  the  State  appropriates  an  equal  amount. 
Bills  are  now  before  Congress  providing  similar  methods  for  the  development  of 
physical  training,  for  improvements  in  education,  for  the  treatment  of  venereal 
diseases,  and  for  other  projects,  all  good  in  themselves,  but  activities  which  belong  to 
the  State  and  local  authorities.  It  is  not  strange  that  this  method  has  become  popular 
with  those  who  have  pet  measures  to  advance.  It  has  the  advantage  of  simplicity. 
It  is  only  necessary  to  indiice  Congress  to  appropriate  a  certain  sum  to  be  divided 
among  the  various  States. 

"This  prospective  grant  is  then  used  as  an  inducement  to  the  States  to  appropriate 
equally  large  sums.  The  advocates  of  this  plan  apparently  regard  the  Federal 
Treasury  as  an  inexhaustible  reservoir,  entirely  overlooking  the  fact  that  such  increas- 
ing appropriations  will  necessitate  heavier  Federal  taxes  to  be  matched  with  heavier 
State  taxes,  all  of  which  must  be  paid  eventually  by  the  common  citizen.  That  the 
so-called  Federal  aid  plan  is  economically  unsound  has  already  been  pointed  out  by 
some  of  our  leading  financial  authorities. 

"Another  objection  is  centralized  administration.  How  would  the  proposed  plan 
work  out?  Some  State,  say  Minnesota,  would  receive  |10,000  for  administration 
expenses,  with  its  additional  pro  rata,  probably  |30,000  in  all,  provided  the  legislature 
appropriated  $30,000.  This  would  give  the  State  department  of  health  $60,000  for 
maternal  and  child  welfare.  Splendid !  But  it  could  not  expend  this  sum,  one-half 
of  which  is  its  own  money,  until  its  plans  had  been  approved  by  the  Children's  Bureau 
in  Washington. 

"The  care  of  mother  and  child  is  a  State  and  local,  not  a  Federal  functioii. 
All  will  agree  that  every  mother  and  child  should  receive  proper  care.  So 
should  every  mother  and  child  receive  suitable  nourishment.  But  it  is  not  the 
function  of  the  Federal  Government  to  provide  either  food  or  care.  There  are  certain 
public  health  functions  which  are  clearly  national  in  character;  others  which  should 
be  performed  by  the  State;  and  still  others  which  belong  to  the  local  government. 
As  pointed  out  by  Dr.  Billings  in  this  issue,  the  rational  method  of  providing  proper 
care  for  the  individual  is  through  voluntary  self-taxation  of  voters  in  a  political  unit 
to  pay  for  the  necessary  local  facilities  for  the  prevention  of  disease  and  the  promotion 
of  health.  While  this  may  seem  slow  as  compared  with  the  more  popular  plan  of 
securing  an  appropriation  from  Congress,  it  is  the  method  by  which  our  public  health 
machinery  in  this  country  has  been  developed,  and  is  the  method  which  will  yield 
the  most  satisfactory  results  in  the  long  run. 

"the  sheppard-towner  bill. 

"As  stated  in  our  news  columns,  the  Senate  Committee  on  Education  and  Labor, 
May  20,  reported  favorably  on  the  Sheppard-Towner  bill.  This  bill,  considerably 
amended,  now  provides  for  the  appropriation  of  $1,480,000,  $10,000  to  be  paid  to  each 
State  and  $1,000,000  to  be  apportioned  among  the  States  in  proportion  to  their  popu- 
lation, no  part  of  the  prorated  amount  to  be  paid  until  an  equal  sum  shall  have  been 
appropriated  by  the  legislature  of  the  State  for  the  purposes  provided  for  in  the  act 
The  Children's  Bureau  is  made  responsible  for  the  administration  of  the  act;  the  chiei 
of  the  Children's  Bureau  is  directed  to  form  an  advisory  committee  consisting  of  tin 
Secretary  of  Agriculture,  the  Surgeon  General  of  the  United  States  Public  Healtl 
Service,  and  the  United  States  Commissioner  of  Education.  Not  more  than  3  pei 
cent  of  the  total  appropriation  may  be  used  for  administration  expenses.  Any  Stat( 
desiring  to  avail  itself  of  the  benefits  of  the  act  must  submit  to  the  Children's  Bureai 
a  detailed  plan  for  instruction  in  the  hygiene  of  maternity  and  infancy  through  publi< 
health  niirses,  concentration  centers  and  other  suitable  methods.  To  meet  th( 
objections  of  the  advocates  of  personal  liberty,  an  amendment  provides  that  no  Stat» 
official  or  agent  or  any  of  the  employees  of  the  Children's  Bureau  shall  have  the  righ 
to  enter  any  home  over  the  objection  of  the  parents.  The  report  of  the  committee  i 
practically  the  same  as  the  report  of  the  Senate  committee  on  the  same  bill  in  the  las 
session  of  Congress.  It  repeats  the  statement  that  the  United  States  stands  seventeentl 
among  civilized  nations  in  its  maternal  death  rate;  that  most  of  this  loss  could  b' 
prevented  by  proper  prenatal  instruction,  and  that  the  bill  has  the  unanimou 
approval  of  women  throughout  the  country.    As  stated  in  a  previous  issue,  th 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  87 

Journal  does  not  favor  this  measure,  since:  (1)  The  principle  of  Federal  State  aid  as 
a  means  of  linancing  public  health  work  is  an  unsound  financial  policy;  (2)  public 
health  work,  except  those  activities  which  are  clearly  national  in  cnaracter.  is  essen- 
tially a  function  of  the  State  and  local  government  and  should  be  paid  for  out  of 
State  and  local  funds;  (3)  no  such  emergency  exists  as  has  been  claimed,  and  there 
are  no  reliable  statistics  by  which  it  can  be  proved  that  the  United  States  stands 
seventeenth  in  maternal  death  rate;  (4)  the  means  provided  in  the  bill  will  not  afford 
an  effective  remedy  for  existing  conditions,  and  (5)  and  most  important,  if  the  Federal 
Government  intends  to  inaugurate  activities  for  the  care  of  maternity  and  infancy  or 
for  any  other  public  health  measure,  such  work  should  be  placed  in  the  hands  ofth© 
United  States  Public  Health  Service  rather  than  under  a  bureau  of  the  Department 
of  Labor." 

Mr.  Mapes.  Doctor,  can  you  specify  a  little  more;  in  detail  in  just  what  way  you 
think  this  bill  would  invade  the  jurisdiction  or  province  of  the  medical  profession?... 

Dr.  IIuMiSToy.  Yes,  sir.  This  l)ill,  in  order  to  apply  to  a  State  at  all,  specifies  >/ 
that  the  Children's  Bureau  shall  make  specific  rules  which  must  be  complied  with.  ^ 
In  other  words,  the  health  departments,  or  the  children's  departments,  in  the  various 
States  must  obey  the  rules  of  a  central  power  here  in  Washington.  I  would  make 
the  further  statement  that  this  is  a  medical  f|uestion,  and,  consequently,  it  can  not 
be  separated,  because,  whatever  the  supervision,  it  is  there  just  the  same,  it  is  a 
supervision  over  what  is  done  in  the  State,  over  what  is  done,  for  instance,  in  Chicago. 

Mr.  Mapes.  Your  notion  would  l)e  that  whatever  supervision  the  doctor  must  have 
should  be  through  the  public  health  oflicials  of  the  State? 

Dr.  HuMiSTON.  It  should  originate  in  the  States,  just  the  same  as  the  license  and 
everything  else  concerning  the  practice  of  medicine. 

Mr.  Mapes.  Is  it  your  notion  that  this  bureau  would  have  any  control  over  the 
individual  practititioner? 

Dr.  HuMiSTON.  With  an  emplovee  responsible  to  this  bureau,  indirectlv  but 
responsible  all  the  same,  visiting  the  same  patients  as  I  visit  as  a  physician,  1  think 
it  would  be  interfering  with  my  business. 

Mr.  Mapes.  Under  the  provisions  of  this  bill,  will  any  one  be  compelled  to  visit 
your  patients? 

Dr.  HuMisTON.  No,  sir;  they  are  not  compelled  to  send  someone,  and  neither  am 
I  compelled  to  make  calls  when  I  am  sent  for,  but  the  fact  of  the  business  is,  this 
subject  is  so  intensely  interesting,  being  the  biggest  thing  on  earth,  where  there  is 
anything  of  this  sort  done,  women  ^vill  seek  information.  They  ask  their  neighbors 
for  information.  Of  course,  there  is  need  for  this  sort  of  instruction,  but  it  should 
not  come  from  any  but  competent  sources. 

Mr  Mapes.  Do  you  recognize  any  field  between  no  instruction  at  all  and  that 
Avhich  the  patient  gets  through  employing  an  individual  doctor? 

Dr.  lluMiSTON.  I  am  not  quite  clear  as  to  what  you  mean. 

Mr.  Mapes.  Do  you  recognize  that  there  is  anything  to  be  done  for  the  general 
])ublic  or  for  the  expectant  mother  that  can  not  be  clone  except  through  the  individual 
doctor? 

Dr.  lIuMiSTON.  Certainly;  there  are  proper  acti\'ities  for  the  Department  of  Public 
Health,  under  whatever  name  it  is  operating.  There  are  proper  activities  for  them, 
and  the  medical  profession  is  perfectly  willing  to  cooperate  with  them.  Then,  there 
are  points  of  natural  antagonism.  There  are  points  of  instruction  that  are  bound  to 
meet.  Doctors  can  not  have  everything  they  want  in  the  practice  of  medicine,  and 
the  ])ublic  health  authorities  here  and  there  must  encroacn  upon  them.  Certainly 
there  is  a  place  for  this  instruction,  but  what  we  ol)ject  to  is  that  the  Children's  Bureau 
takes  over  health  matters  bodily  and  undertakes  to  supervise  a  question  which  is 
essentially  medical,  and  which,  without  medical  knowledge  back  of  it,  makes  the 
supervision  worse  than  useless. 

Mr.  Mapes.  Perhaps  I  have  asked  this  question  in  a  different  form:  Do  you  think 
that  this  bill,  or  the  provisions  of  this  bill,  would  apply  to  those  people  who  are  able 
to  have  and  who  do  have  a  family  physician,  or  who  emi)loy  a  doctor? 

Dr.  IIuMiSTON.  I  can  only  gather  the  purpose  of  the  bill  from  the  way  in  which  it 

is  WTitten,  just  what  those  people  who  got  this  bill  up  had  in  mind  would  have  nothing 

itelwhatever  to  do  with  its  a]iplication.     It  says  in  section  10  that  anybody  who  asks  for 

|tl  it  can  have  this  assistance,  and  that  means  that  the  whole  population  is  free  to  share 

i^in  its  benefits,  if  it  has  any  benefits.     I  do  not  understand  that  it  is  limited  to  poor 

people  or  to  people  who  have  no  physicians.     It  is  a  fact  that  well-to-do  mothere  will 

go  to  these  baby  centers  and  get  information  which  they  do  not  assimilate  or  under- 

bf  stand — information  that  they  are  not  com])etent  to  luiderstand,  and  they  often  take 

}iii  issue  with  the  familv  doctor."    Now,  it  may  be  that  sometimes  they  are  right,  and  have 

tli(  better  information  than  the  familv  doctor  can  give,  but,  for  the  most  part,  they  are 


88  PUBLIC  PROTECTION"  OF  MATERNITY  AND  INFANCY. 

wrong,  and  there  is  strife  stirred  up  by  the  center.  I  claim  for  the  practice  of  medi- 
cine, for  the  medical  profession,  that  it  has  a  riaht  to  exist  under  the  very  best  con- 
ditions, because  we  are  all  interested  in  that,  and  whenever  the  practice  of  medicine 
becomes  in  any  way  impaired  through  legislation  or  other  means  the  country  is  bound 
to  suffer. 

Mr.  Mapes.  Are  you  opposed  to  those  infant  centers  or  clinics? 

Dr.  HuMiSTON.  If  you  will  pardon  me  for  confining  my  attention  to  this  bill 

Mr.  Mapes  (interposing).  My  question  was  asked  because  of  the  statement  you 
made  that  women  who  could  afford  doctors  went  to  the  centers  and  got  notions  that 
were  in  conflict  with  the  views  of  the  doctors. 

Dr.  HuMisTON.  Yes,  sir;  and  my  knowledge  of  that  comes  from  the  officials  of  a 
medical  body  that  has  to  adjust  and  adjudicate  those  things.  Where  they  are  under 
the  supervision  of  the  local  medical  profession,  those  things  are  smoothed  down  and 
properly  taken  care  of.  When  those  things  are  taken  care  of  by  public-health  nurses, 
who  are  responsible  all  the  way  back  to  the  city  of  Washington,  or  to  the  General 
Government,  the  local  medical  authorities  would  not  have  anything  to  say,  except 
to  get  out  of  the  way  of  the  steam  roller. 

Mr.  Mapes.  You  do  not  say  whether  or  not  you  are  opposed  to  the  centers. 

Dr.  HuMiSTON.  I  am  opposed  to  the  centers  which  this  bill  provides.  Now,  if  you 
want  my  private  opinion  about  other  things,  I  will  give  that  to  you  privately,  but  I 
am  now  talking  about  this  bill,  and  we  are  opposed  to  it  for  the  reasons  I  have  given. 

Mr.  Mapes.  I  do  not  care  about  getting  your  opinion  upon  anything  upon  which 
you  do  not  care  to  express  it,  but  you  have  expressed  an  opinion  on  the  centers  that 
now  exist.     If  you  do  not  care  to  express  an  opinion,  I  will  not  ask  you  to  do  so. 

Dr.  HuMtSTON.  Let  me  answer  your  question:  I  have  been  a  medical  teacher  for 
many  years,  and  I  hold  the  chair  of  professor  of  clinical  surgery  in  the  University  of 
Illinois.  We  maintain  dispensaries  at  places  where  we  give  out  this  kind  of  informa- 
tion, and  I  do  approve  that.     I  help  it  out  in  my  feeble  way. 

Mr.  Mapes.  You  object  to  anyone  doing  it  except  through  the  medical  profession? 

Dr.  HuMisTON.  Yes,  sir;  I  do.  I  will  be  perfectly  frank  with  you  about  that. 
If  you  say  it  is  the  practice  of  medicine,  then  I  say  that  I  believe  the  practice  of 
medicine  belongs  among  the  licensed  medical  fraternity,  or  whoever  the  States, 
through  their  representatives,  care  to  license.  They  are  best  qualified  to  do  it  and 
should  be  permitted  to  do  it.  Everyone  else  should  be  required  to  take  orders  from 
that  source.  If  there  were  no  other  objections  to  this  bill,  I  would  object  to  putting 
maternity  matters,  for  sentimental  reasons,  under  a  department  which  originally 
was  created  to  investigate  the  condition  of  children  in  industry.  I  would  object  to 
putting  it  there  for  sentimental  reasons  solely  because  the  head  of  that  bureau  happens  ' 
to  be  a  woman,  and  upon  the  theory  that  it  is  a  woman's  question.  It  is  no  more  a 
woman's  question  than  it  is  a  man's  question.  I,  as  a  father,  have  six  extremely  good 
reasons  for  being  particularly  interested  in  this  question,  namely,  Margaret,  Homer 
W.,  Ruth,  Charles  Edward,  jr.,  Helen,  and  Baby  Jean.  I  have  as  much  interest  in 
them  as  has  their  mother,  the  most  divine  woman  I  know  on  the  face  of  the  earth. 

Mr.  Mapes.  I  think  it  would  be  generally  conceded  that  it  would  be  desirable  for 
an  expectant  mother  to  have  a  doctor,  and  that  doctor  would  probably  take  care  of 
her,  but  do  you  think  that  the  medical  profession  as  a  whole  is  very  prone  to  impart 
information  even  to  their  patients? 

Dr.  HuMisTON.  Precautions  against  what — babies? 

Mr.  Mapes.  Precautions  in  the  way  of  doing  what  they  should  do  when  preparing 
or  getting  ready  for  the  baby. 

Dr.  HuMisTON.  I  would  be  ashamed  of  any  member  of  the  medical  profession  who 
would  not  be  glad  to  impart  any  useful  and  wholesome  information  to  any  woman 
under  those  circumstances.  The  medical  profession  stands  for  that,  it  has  been  in 
favor  of  it,  and  is  doing  it. 

Mr.  Mapes.  That  is  your  own  experience. 

Dr.  HuMiSTON.  That  is  my  observation,  and  it  has  not  been  very  limited,  either. 
The  organized  medical  profession,  the  American  Medical  Association,  has  distributed , 
more  than  3,000,000  pamphlets  on  the  subject  of  maternity.  , 

Mr.  Mapes.  I  understood  you  to  say  that  you  were  in  favor  of  the  purposes  of  this  | 
bill.     Is  that  correct?  j 

Dr.  HuMiSTON.  For  the  protection  of  maternity  and  infancy,  and  that  is  where  I ; 
stop.     That  is  stated  as  the  purpose  of  the  bill.     I  take  issue  with  the  waj^  in  which 
it  is  contemplated  that  is  shall  be  done.     I  am  in  favor  of  leaviag  this  to  the  States, 
where  it  belongs,  and  I  say  that  this  bill  ought  to  be  killed  in  the  committee,  or,  if  |,' 
it  must  come  out,  it  should  be  put  to  sleep  at  the  bottom  of  the  calendar.  |f 

Mr.  Mapes.  You  say  that  you  are  in  favor  of  giving  protection  to  women  and  infant?, '  i 
In  just  what  way  would  you  do  that?    Would  you  leave  it  entirely  to  the  private 
initiative  of  the  medical  profession? 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  89. 

Dr.  HuMisTON.  I  would  leave  it  to  the  State  to  provide  charity  for  those  who  re- 
quire it,  and  I  would  leave  the  practice  of  medicine  to  the  practitioners  of  medicine, 
and  when  those  instrumentalities  fall  short  in  any  State,  let  the  State  devise  other 
ways.  I  think  there  is  coming  to  be  more  and  more  publicity  of  information  in  health 
matters,  and  that  is  a  very  proper  activity.  There  is  more  and  more  publicity  from 
medical  quarters  and  from  medical  sources,  as  I  have  already  stated.  We  are  pro- 
gressing in  that  respect,  and  no  doctor  who  is  worthy  the  name  of  physician  objects 
to  having  an  intelligent  patient  instructed. 

Mr.  Sweet.  Let  me  see  if  I  understand  your  position:  As  I  understand  you,  the 
matters  involved  in  this  bill  are  wholly  matters  for  the  medical  profession? 

Dr.  IIuMisTON.  Ninety-five  per  cent  I  gave  as  the  figure,  and  I  am  willing  to  stand 
on  that.     That  shows  the  preponderance  of  it. 

Mr.  Sweet.  That  applies  as  well  to  the  State  as  to  the  Federal  Government? 

Dr.  HuMiSTON.  The  States  are  not  owned  and  controlled  by  the  physicians,  but  the 
physicians  are  the  creatures  of  the  State.  The  State  retains  its  authority  to  deal  with 
them  as  it  pleases. 

Mr.  Sweet.  I  realize  that,  but  I  am  trying  to  get  at  your  thought  in  regard  to  this 
matter,  not  so  much  your  position  on  the  bill  itself,  but  your  view  as  to  the  whole 
situation  from  a  medical  standpoint — that  is  to  say,  instead  of  having  a  separate  or- 
ganization, you  believe  that  it  should  be  a  part  of  the  medical  administration  of  the 
State. 

Dr.  HuMisTON.  That  states  it  very  well.  Without  attempting  to  define  what  part 
of  it  could  best  be  handled  by  the  State  through  State  employees,  I  agree  with  your 
statement  of  it.     That  is  what  I  am  trying  to  say. 

Mr.  Sweet.  Your  position  is  that  whatever  instruction  goes  out  should,  in  fact, 
emanate  from  and  be  under  the  supervision  of  the  medical  profession.  Your  con 
elusion  is  that  whatever  instruction  is  sent  out  or  whatever  education  is  imparted 
should  be  by  well-defined  methods  under  medical  supervision? 

Dr.  liuMisTON.  Practically  so.  I  believe  that  any  medical  instruction  intended 
for  the  public  as  a  whole,  and  which  applies  interstate  to  the  whole  country,  and 
which  is  a  matter  between  the  States  and  is  national  in  character,  should  be  taken  care 
of  by  the  Federal  Department  of  Public  Health,  instead  of  by  the  Childien's  Bureau 
or  any  other  bureau  under  anv  department;  but  I  believe  that  essentially  all  of  this 
belongs  to  the  State,  and  such  part  of  it  as  can  best  be  administered  or  done  by  the 
State  should  be  done  by  the  departments  of  health  in  the  various  States. 

Mr.  Sweet.  Ij  other  words,  your  position  is  this:  That  whatever  instruction  is  given 
by  nurses,  or  by  those  who  have  not  been  properly  licensed  by  the  State,  should,  in 
fact,  be  under  the  supervision  and  direction  of  the  medical  profession? 

Dr.  HuMisTON.  Yes,  sir;  by  the  municipal  health  authorities,  or  State  health  au- 
thorities, the  heads  of  which  are  doctors. 

Mr.  Sweet.  That  is,  in  order  that  the  information  that  is  given  may  be  correct  and 
along  proper  lines,  the  infoimation  should  come  from  the  profession  and  not  from 
nurses  or  others  who  have  not  made  a  life  study  ot  the  question  or  subject.  Is  that 
your  position? 

Dr.  HuMisTON.  I  think  that  the  best  is  none  too  good  for  anyone  under  such  cir- 
cumstances and  the  medical  profession  is  the  source  ot  our  b3st  information.  I  have 
had  something  to  do  with  the  education  of  nurses  for  many  yeai's,  and  I  have  the 
highest  regard  for  what  they  know  and  do,  but  they  are  not  the  best  persons  to  give 
technical  information,  and  this  is  a  technical  subject,  despite  the  fact  that  the  bill 
says  something  about  its  nontechnical  nature.  I  am  frequently  asked  questions  that 
I  am  unable  to  answer,  and  naturally  so,  but  I  can  come  nearer  to  answering  them 
than  the  nurse  who  has  l;een  listening  to  my  lectures  for  a  time,  and  some  of  them  are 
likely  to  be  Public-Health  nurses  a  little  while  later.  I  believe  that  any  doctor  who 
is  worthy  the  name  can  give  better  and  safer  advice  and  instruction  of  a  medical 
nature  to  prospective  mothers  than  can  Public-Health  nurses.  Some  one  may  have 
to  help  those  women,  those  poor  women,  with  their  babies — that  is,  advice  how  to 
feed  them,  how  to  wash  them  and  put  on  their  clothes,  and  in  not  a  few  instances 
somebody  must  furnish  the  clothes  for  the  child's  body  where  the  parents  are  very 
poor.  Now,  where  will  you  stop?  Do  you  wish  to  legislate  and  appropriate  moneys 
to  supply  the  needs  of  those  children?  Then,  let  us  buy  flour,  sugar,  meat,  and 
provide  fresh  air  for  those  poor  mothers.  Let  us  take  care  of  the  housing  conditions 
and  all  the  economic  questions.  Those  economic  questions  are  powerful  elements. 
It  is  not  just  a  question  of  medicine.  That  being  true,  why  use  medicine  as  an  ex- 
cuse to  invade  the  police  power  of  the  States,  when  the  medical  part  is  taken  care  of 
better  than  most  of  those  other  things? 

Mr.  Sweet.  I  presume  you  have  read  the  testimony,  or  heard  the  testimony,  in 
regard  to  the  conditions  in  the  city  of  New  York  and  as  to  what  is  being  done  there . 
Would  you  say  that  that  is  being  conducted  in  a  proper  way? 


J90  PUBLIC   PKOTECTION    OF   MATERNITY  AND   INFANCY. 

Dr.  HuMiSTON.  If  you  will  qualify  that  word  "proper,"  I  will  say  that  they  are 
doing  very  2:ood  work,  having  in  mind  the  conditions.  If  that  is  what  you  mean  by 
"proper,"  I  say  yes;  but  if  you  mean  that  they  are  not  making  mistakes,  that  they 
are  not  wasting  effort,  that  they  are  not  doubling  on  their  tracks,  etc . ,  I  want  to  qualify 
it  a  little.  I  believe  that  the  health  departments  of  all  the  large  cities  are  doing  good 
work.  I  know  they  are .  The  issue  I  take  is  with  the  proposition  that  the  good  results 
they  are  obtaining  are  any  indication  of  what  would  be  accomplished  for  the  rest  of 
the  country  if  you  should  pass  this  bill.  There  is  no  parallel  between  the  two  things 
at  all. 

Mr.  Sweet.  Your  view  of  it  is  that  the  nurses  and  other  agencies  should  be  sub- 
ordinate to  the  medical  profession  in  imparting  advice  and  knowledge  in  regard  to 
the  objects  set  forth  in  this  bill? 

Dr.  HuMiSTON.  I  do.  I  do  not  recognize  the  so-called  nursing  profession  as  a  pro- 
fession, pure  and  simple,  but  nurses  are  assistants  to  the  medical  practice  in  its  proper 
and  wide  sense.  They  are  carrying  out  orders,  and  if  you  permit  nurses  to  act  on 
their  own  initiative,  then  they  are  practicing  medicine,  which  is  in  conflict  with  the 
laws  of  every  State.     I  know  that  they  are  inclined  to  do  that. 

Mr.  Sweet.  In  the  city  of  New  York,  I  believe,  they  are  in  a  sense  considered  to 
be  a  profession. 

Dr.  HuMisTON.  In  that  ordinary  sense,  I  say  that  druggists  belong  to  a  profession. 
I  do  not  want  to  split  hairs  in  making  these  distinctions,  but  they  are  not  an  inde- 
pendent profession.  They  have  a  part  in  it  under  the  direction  of  somebody  else, 
whose  instructions  they  are  following  out.  Now,  if  this  bill  is  carried  further,  and  if 
it  were  put  under  the  head  of  the  Children's  Bureau,  where  would  they  go  for  their 
information?  They  would  have  to  hire  doctors.  Now,  the  practice  of  medicine  is 
an  intensely  personal  thing,  and  it  can  not  be  made  anything  else.  So  far  as  the 
science  of  medicine  is  concerned,  it  is  general,  but  the  application  of  medical  prin- 
ciples to  an  individual  in  medical  practice  is  a  personal  thing.  It  is  an  art.  and  the 
State  is  no  artisan.  It  can  not  do  it,  and  will  never  learn  to  do  it.  There  are  some 
great  questions  of  hygiene  and  sanitation,  such  as  are  involved  in  the  handling  of 
yellow  fever  and  malaria,  that  are  proper  activities  of  the  Government.  Those  are 
questions  of  hygiene  and  sanitation.  The  treatment  of  the  sick  is  a  matter  for  the 
medieal  profession.  Now,  if  a  woman  is  not  sick  she  does  not  need  instruction  from 
that  source.  There  has  been  some  mention  here  of  advice  in  regard  to  albuminuria. 
I  would  like  to  know  how  a  Public  Health  nurse  is  going  to  know  much  about  the 
treatment  of  eclampsia.  If  you  know  of  any  that  can  do  so,  then  I  would  like  to 
hear  some  of  her  lectures  on  the  subject.  I  do  not  understand  that  complication  of 
pregnancy  very  well,  but  I  am  satisfied  that  the  medical  profession  knows  more  about 
it  than  any  nurse  and  is  better  qualified  to  give  advice  in  regard  to  it  than  any  nurse 
would  be  in  passing  it  to  a  woman  who  scarcely  understands  the  English  language . 

Mr.  Denison.  Of  course,  the  expenditure  of  funds  by  the  State  governments  for 
health  purposes  is  commendable,  is  it  not? 

Dr.  HuMisTON.  Yes,  sii;  as  an  abstract  proposition,  certainly  it  is.     . 

Mr.  Denison.  What  do  you  think  of  the  propriety  of  the  Federal  Government 
contributing  a  certain  amount  of  money  to  the  different  States  as  a  means  of  encourag- 
ing contributions  by  the  States,  and,  at  the  same  time,  not  retain  the  right  to  dictate 
control  of  the  expenditure  of  the  money,  but  leave  that  to  the  State?  What  do  you 
think  of  the  wisdom  of  that  plan? 

Dr.  HuMiSTON.  I  can  not  conceive  of  the  contribution  of  money  by  the  Federal 
Government  for  the  encouragement  of  the  States,  because  the  Federal  Government 
has  no  money  except  as  it  raises  it  by  taxation.  It  has  to  get  its  money  from  the 
people  of  the  States.  It  can  only  get  its  money  by  taxing  the  people,  and  it  is  not 
getting  something  for  nothing.  1  can  not  see  any  parallel  between  this  proposition 
and  Federal  contributions  to  good  roads  and  agricultural  needs  that  have  been  encour- 
aged in  that  way.  I  can  not  see  any  parallel  between  those  things  at  all,  but  I  do  see 
the  injustice  of  taking  away  $10  from  the  State  of  Illinois  and  giving  $4  of  it  to  some 
other  State  that  does  not  pay  hardly  anything.  I  do  see  the  injustice  of  that  as  an 
economic  proposition. 

Mr.  Denison.  If  that  State  that  you  refer  to  does  not  spend  any  money  or  contribute 
any  money  for  the  purpose,  do  you  not  think  that  the  Nation  should  take  cognizance 
of  that  fact  from  the  standpoint  of  not  doing  anything  to  help  the  people  of  a  State 
who  will  not  help  themselves? 

Dr.  HuMiSTON.  I  think  that  the  guide  to  the  activities  of  the  Congress  of  the  United 
States  is  well  laid  down  in  the  Constitution,  and  if  these  activities  come  within  the 
lines  there  laid  down,  then  it  can  not  be  gainsaid  that  they  should  be  done,  but  when 
it  comes  to  doing  it  in  the  way  which  I  think  is  contemplated  in  this  bill,  then  I 
think  I  should  raise  my  voice  against  it. 


PUBLIC  PROTECTION   OF   MATEENITY   AND  INFANCY.  91 

Mr.  Denisox.  I  am  not  trying  to  get  at  that,  or  as  to  %vhat  this  bill  does.  You 
seem  to  take  exception  to  the  fact  that  the  Federal  Government  should  take  control 
through  this  bureau  and  have  the  right  to  make  the  aid  granted  the  State  conditional 
upon  the  State  accepting  the  terms  im])08ed  by  the  bureau.  Now,  suppose  the  Fed- 
eral Government  should  simply  make  an  appropriation  as  a  matter  of  encouragement 
to  the  States  to  induce  them  to  make  similar  appropriations,  without  retaining  any 
control  over  the  manner  in  which  the  funds  ara  to  be  expended.  Do  you  think  that 
would  be  commendable,  or  would  it  be  subject  to  criticism? 

Dr.  HuMisTox.  I  can  not  conceive  how  you  could  do  that  without  maintaining 
some  sort  of  control  over  the  money  that  is  contributed,  and  that  means  some  sort  of 
political  machinery.  If  you  want  to  make  the  State  of  Illinois  a  present  of  .$100,000 
to  do  what  it  pleases  .vith,  I  would  not  think  much  of  that  as  an  action  of  Congress 
representing  the  people  of  the  whole  country.  If  you  give  .$100,000  to  the  State  of 
New  York,  "there  is  bound  to  be  some  sort  of  restriction  attached  by  which  you  can 
see  that  the  money  is  not  wasted.  I  do  not  believe  that  a  supposition  like  that  is 
tenable,  and  I  can  not  answer  it .  If  you  mean  to  say  that  it  is  a  good  thing,  and  that 
the  Government  can  put  up  money  for  it  from  somewhere  so  that  it  shall  not  cost 
anybody  anything  to  get  it,  then,  I  would  like  to  have  some  of  that  myself.  I  would 
like  to  have  some"  of  that  to  go  home  on,  if  it  were  not  going  to  hurt  anything  or  any- 
body. I  do  not  want  to  treat  your  question  lightly,  but  I  can  not  see  that  that  could 
be  done .  I  do  not  see  how  you  could  give  money  to  the  State  for  any  purpose  without 
assuming  the  obligation  to  see  that  the  money  is  spent  properly.  I  believe  that 
there  is  complaintali  over  the  countiy  that  money  raised  and  expended  by  Congress 
has  not  been  expended  advantageously  in  every  case.  I  believe  that  those  criticisms 
are  not  justified  all  the  time,  but  I  know  that  those  criticisms  are  being  repeatedly 
heard. 

Mr.  Dentsox.  The  State  Medical  Society  of  Illinois  has  gone  on  record  on  this  par- 
ticular bill,  has  it  not? 

Dr.  Huxii.'JTox.  Through  their  acti^'ities  and  resolutions  in  the  house  of  delegates  the 
whole  energy  of  the  association  has  been  directed  against  it.  They  were  instrumental 
largely  in  defeating  senate  bills  introduced  by  Mr.  Glacken,  which  would  have 
accepted  the  provisions  of  this  bill. 

^Ir.  Dexisox.  .^s  I  remember,  last  year,  when  this  bill  was  under  consideration,  I 
received  a  copy  of  a  resolution  passed,  according  to  my  recollection,  by  the  State 
medical  society  disapproving  this  bill. 

Dr.  HuMiSTox.  I  was  afraid  you  were  about  to  ask  me  for  a  copy  of  those  resolu- 
tions. I  did  not  come  here  aj-med  with  statistics  and  resolutions  for  submission  to 
the  committee,  but  I  am  wilUng  to  send  you  anything  that  I  can  supply. 

Mr.  Dexisox.  Am  I  right  about  that,  or  did  they  pass  a  resolution? 

Dr.  HvMisTox.  They  have  repeatedly  done  it.  I  do  not  know  which  one  you 
have  reference  to,  but  there  is  no  question  about  the  attitude  of  the  medical  profes- 
sion in  Illinois  on  this  1)111. 

Mr.  Dexisox.  AVhat  did  the  Glacken  bill  refer  to? 

Dr.  HuMisTox.  Those  bills  were  senate  bills.  They  were  maternity  bills  on  this 
proposition.  I  do  not  know  that  these  are  the  right  numbers,  but,  if  I  am  not  mis- 
taken, they  were  numbers  10,  223,  and  134.  Whatever  their  numbers,  however, 
there  were  several  of  them,  and  as  fast  as  one  was  squelched  in  committee  another 
one  would  bob  up.  One  provision  in  them  was  that  if  such  a  bill  as  this  should  be 
passed  by  Congress,  the  Department  of  Public  Health  of  Illinois  could  take  advantage 
of  the  funds.  It  was  an  enabling  act  to  take  advantage  of  the  money  that  would  be 
available  under  this  bill. 

Mr.  Dexisox.  Do  you  know  the  rea.'^on  why  they  did  not  pass,  or  why  they  did 
not  receive  favorable  consideration? 

Dr.  HiMisTox.  Well,  I  can  not  give  you  all  the  motives.     They  were  killed  in 

commiitee,  and  upon  about  such  an  argument  as  I  am  endeavoring  to  pr&sent  here. 

That  argument  was  presented  by  Dr.  (  hapman,  who  happened  to  be  present.     That 

particular  l)ill  was  killed  in  the  committee  right  there,  and  they  never ,did  have  any 

.  chance  to  pass  it. 

Mr.  Bi'HROT'fiiis.  1  understood  you  to  say,  in  answer  to  Mr.  Denison"s  questions, 
that  you  did  not  see  any  way  by  which  this  Federal  money  could  be  appropriated 
for  this  very  commendable  object  unless  some  one  on  the  part  of  the  Federal  Gov- 
ernment, that  is,  some  biireau  or  some  peiTon,  should  have  the  right  to  say  whether 
or  not  it  was  being  used  in  accordance  with  the  provisions  of  the  bill.  Is  that  your 
position? 

Dr.  HuMisTox.  My  statement  was  that  I  did  not  understand  that  Congress  could  1  e 
expected,  or  really  would  have  the  right,  representing  the  people,  to  appropriate 
money  and  let  go  of  it.  regardless  of  the  purpose  for  which  it  was  used.  Under  con- 
ceivable conditions  it  might  be  used  to  buv  votes  in  the  legislature. 


92  PUBLIC  PEOTECTIOF   OF  MATERIsTITY  AND  INFANCY. 

Mr.  Burroughs.  Would  you  think  it  possible  to  have  written  in  the  bill  certain' 
definite  conditions  upon  which  or  upon  compliance  with  which  money  should  be- 
paid  to  the  State,  and  upon  noncompliance  with  which  it  should  not  be  paid  to  the 
State,  and  thus  not  leave  this  whole  thing  to  the  discretion  of  any  individual,  whether- 
he  or  she  is  at  the  head  of  the  Children's  Bureau,  at  the  Head  of  the  Public  Health; 
Service,  or  any  other  bureau?  In  other  words,  that  it  be  a  matter  of  law  to  be  deter- 
mined by  the  courts  whether  or  not  the  State  has  fulfilled  the  conditions  laid  down; 
in  the  act  itself.     Is  that  possible? 

Dr.  HuMiSTON.  That  question  is  somewhat  involved,  but  I  do  not  believe  it  could 
possibly  be  done  and  still  be  right.  Really  I  think  that  the  only  thing  that  could 
properly  be  done  in  changing  this  bill  would  be  to  strike  out  lines  1  and  2.  I  believe- 
that  the  bill  is  intended  by  the  people  who  got  it  up  as  one  of  the  best  of  things,  but 
I  am  convinced  that  it  will  fail  of  its  purpose  and  that  the  net  result  will  be  more- 
harm  than  good.  Primarily  and  logically  the  Children's  Bureau  is  not  presumed  to^ 
understand  the  question  involved  in  this  bill.  I  know  the  head  of  this  department, 
and  I  admire  her  very  much,  and  there  is  nothing  personal  in  this  at  all. 

Mr.  Hawes.  Doctor,  do  you  know,  approximately,  how  much  the  State  of  Illinois 
spends  annually  on  its  health  department? 

Dr.  Humiston.  I  can  not  give  you  those  figures,  but  they  are  readily  available. 

Mr.  Hawes.  Do  they  run  into  the  millions? 

Dr.  Humiston.  They  run  into  large  amounts,  considering  the  amount  of  territory 
covered,  and  they  are  not  given  grudgingly  by  the  legislature. 

Mr.  Hawes.  And  the  amount  that  is  spent  by  the  State  is  supplemented  by  munic- 
ipal health  departments  in  all  your  cities,  is  it  not? 

Dr.  Humiston.  In  the  larger  cities.  In  Chicago  the  municipal  authorities  do  prac- 
tically all  of  it;  only  a  little  of  the  State's  fund  is  spent  there,  and  for  the  most  part 
the  city  of  Chicago  takes  care  of  its  own  work. 

Mr.  Hawes.  What  I  am  trying  to  get  at  is  this:  Under  this  bill  Illinois  would  be 
entitled  to  110,000,  and  then  to  its  proportion  of  $1,000,000,  say,  approximately, 
$30,000.  The  total  amount  Illinois  would  receive  would  be  about  $40,000.  As 
compared  with  the  total  amount  spent  in  Pennsylvania,  it  was  $40,000  as  against  five 
or  six  million,  and  I  wanted  to  know  what  the  proportion  would  be  in  Illinois? 

Dr.  Humiston.  I  have  not  the  figures  and  I  would  have  to  do  a  little  mathematical 
calculation  here.    We  are  almost  as  large  a  State  as  Pennsylvania. 

Mr.  Hawes.  I  want  to  know  what  portion  of  national  control  would  be  given  over 
the  health  ser.vice  of  a  State  where  the  Nation  invests  $40,000  and  the  State  invests 
from  $5,000,000  to  $6,000,000. 

Dr.  Humiston.  I  think  that  question  is  parallelled  by  this  statement:  What  is  the 
size  of  the  camel's  nose  in  order  that  we  may  know  what  it  will  be  when  it  gets  its 
body  into  the  tent.  This  is  the  opening  wedge.  Who  suspects  that  $1,000,000  will 
carry  on  this  work  when  it  gets  started?  Who  ever  heard  of  an  activity  of  this  kind 
that  did  not  expand?  Are  not  the  words  billions  instead  of  millions  already  in  the 
testimony  that  has  been  presented  here?  It  is  the  beginning  we  are  trying  to  fight. 
If  you  pass  this  thing  with  1  cent  to  be  donated  by  Henry  Ford  for  each  State,  I  would 
still  object  to  it. 

Mr.  Hawes.  Doctor,  you  and  I  will  get  along  faster  if  you  will  follow  my  questions. 

Dr.  Humiston.  I  thought  I  was  answering  it. 

Mr.  Hawes.  If  in  Illinois  there  is  the  same  ratio  as  in  Pennsylvania,  it  will  be  about 
1,000  to  1  of  State  money  as  against  national  money.  In  section  8  of  this  bill  the 
direction  of  State  control  is  to  be  left  to  a  board  or  to  some  officers  who  are  not  yet 
appointed,  and  they  can  make  such  rules  and  regulations  as  they  desire,  which  are 
not  written  in  this  law,  and  with  a  national  investment  of  $40,000  seek  to  control  a 
State  investment  of  $5,000,000  or  $6,000,000? 

Dr.  Humiston.  Let  me  straighten  out  your  question,  if  I  may.  You  are  presuming- 
that  this  bill  says  that  this  board,  not  yet  appointed,  may  do  as  it  pleases.  This  bill 
says  it  has  to  come  up  to  the  regulations  of  the  department  right  in  this  city  or  it  can 
not  have  any  money  to  spend. 

Mr.  Hawes.  Doctor,  I  am  objecting  to  this  bill  in  its  present  form  because  there 
are  at  this  time  no  regulations  and  we  do  not  know  what  they  will  be.  We  first  pass 
the  law  and  then  this  board  writes  the  law  so  far  as  the  regulations  are  concerned. 

Dr.  Humiston.  If  you  have  some  valid  objection  to  this  bill  that  I  have  not  heard 
of,  I  want  to  say  Amen  to  it.     ]Laughter.] 

Mr.  Sanders.  Whether  it  is  sound  or  not. 

Mr.  Hawes.  I  have  one  other  question.  In  this  maternity  question,  several  wit- 
nesses have  said  that  its  causes  are  divided  into  three  classes,  economics,  social,  and 
hygienic,  in  which  proportion,  in  your  opinion,  do  each  of  these  causes  affect  the  total. 


PUBLIC  PROTECTTON"   OF   MATERNITY  AND  INFANCY.  93 

Dr.  IIuMisTON.  T  can  only  give  you  an  opinion  more  or  less  off-hand.  I  had  in 
mind  what  this  bill  is  talking  about,  and  that  is  nearly  all  medical.  I  do  believe  there 
is  a  very  large  part  of  influence  affecting  maternity  and  child  bearing  and  child  rearing, 
that  is  a  matter  of  dollars  and  cents,  clothing  and  food,  and  houses  and  a  roof  to  keep 
the  rain  out,  and  fuel  to  keep  them  warm,  and  proper  dwellings  to  prevent  overcrowd- 
ing and  to  keep  them  from  communicating  disease  in  ways  which  they  would  not  do 
if  they  had  enough  room  to  sleep;  if  they  did  not  have  to  sleep,  many  of  them,  five  or 
six  in  a  room,  or  five  or  six  in  a  bed.  Those  are  economic  conditions.  I  do  not  under- 
stand that  this  bill  at  present  offers  any  money  to  relieve  those  conditions,  but  I  do 
suspect  and  have  more  grounds  than  a  mere  suspicion,  that  it  .is  the  forerunner  of 
funds  to  give  to  the  family  and  is  fashioned  after  the  laws  in  other  countries  where 
thev  do  that. 

Mr.  Cooper.  Jusl  on  that  point,  are  you  opposed  to  that.  Doctor? 

Dr.  IIu.MisTON.  If  that  were  in  this  bill,  I  would  be  opposed  to  it.  I  am  opposed 
to  anything  that  leads  in  that  direction.     This  bill  involves  the  practice  of  medicine. 

Mr.  Cooper.  But  does  it  involve  the  practice  of  medicine?  Just  a  moment  ago 
you  said  that  undou])tedly  there  was  a  social  question  involved — the  clothing  of  the 
child  and  looking  after  the  comfort  of  the  mother,  etc. — and  then  you  said,  "Where 
is  that  going  to  lead?" 

Dr.  HuMiSTON.  That  remai'k  was  prompted  by  the  question  of  money  coming  up 
all  the  time  and  what  a  very  insignificant  amount  it  was  and  how  much  of  taxes  will 
have  to  be  distributed.  Now,  I  ought  not  to  go  into  that,  probably,  as  I  should  con- 
fine my  remarks  to  the  medical  features  of  this  bill,  which  is  nearly  all  of  it. 

Mr.  Cooper.  Can  you  show  me  in  this  bill  any  provision  which  would  permit  the 
Federal  Government  to  have  super\dsion  over  .$5,000,000  which  the  State  of  Illinois 
might  contribute  to  this  work. 

Dr.  HuMisTON.  This  fund  is  to  be  distributed  and  expended  through  existing  func- 
tions of  the  Government  already  established,  either  its  Children's  Bureau,  if  it  has 
one,  or  one  appointed  by  the  governor  if  the  legislature  has  not  pro^dded  anything 
and  does  not  meet  in  1922.  In  other  words,  it  interlocks  the  expenditure  of  the 
money  with  established  departments  of  the  State  government,  and  I  do  not  see  how 
you  can  separate  them. 

Mr.  Cooper.  Perhaps  I  did  not  make  myself  quite  plain.  You  say  that  if  the  State 
of  Illinois  contributes  15,000,000  to  this  work  and  the  Federal  Government  con- 
tributes $40,000,  you  contend  that  the  Federal  Government  will  have  entire  juris- 
diction over  the  expenditure  of  that  money  under  this  bill. 

Dr.  HuMisTON.  Of  the  other  $5,000,000? 

Mr.  Cooper.  Yes. 

Dr.  HuMisTON.  No;  but  the  Federal  Government  Avill  influence  it  profoundly. 

The  Ch.\irman.  I\Ir.  Hawes,  had  you  finished? 

Mr.  Hawes.  Yes;  except  I  apprehend  I  have  not  understood  the  gentleman.  My 
estimate  regarding  the  appropriation  of  Illinois  was  excessive.  I  believe  it  is  only 
about  two  and  a  half  million  dollars,  but  so  far  as  the  $40,000  would  go  from  the  Unitecl 
States  Government,  it  would  be  given  under  a  set  of  rules  and  regulations  prepared 
by  the  national  department,  and  if  would  run  in  the  ratio  of  $40,000  to  $5,000,000  or 
$2,500,000,  and  my  objection,  Mr.  Cooper,  is  that  the  regulations  are  not  written  into 
the  law.     We  do  not  know  and  we  can  not  know  unless  written  in  this  law. 

Mr.  Cooper.  You  do  not  contend,  though,  Mr.  Hawes,  that  the  Federal  Govern- 
ment would  have  entire  jurisdiction? 

Mr.  Hawes.  Oh,  no;  I  mean  that  its  $40,000,  if  its  regulations  are  accepted,  would 
affect  the  expenditure  of  the  $2,500,000  or  the  $5,000  000. 

The  (  'hairman.  Doctor.  I  would  like  to  have  you  elaborate  a  little  more  the  answer 
which  you  gave  to  a  question  asked  by  Mr.  Cooper  to  this  effect,  as  I  understand  it. 
Would  the  Federal  Government  under  this  bill  through  an  appropriation  have  any 
control  over  the  expenditure  of  the  larger  sum  of  money  that  might  be  appropriated 
l>y  the  State  for  its  work?  I  will  try  to  make  my  statement  and  then  let  you  answer 
as  you  will.  If  the  State  of  Illinois  having  a  standard  of  its  own  and  rules  and  regu- 
lations according,  for  the  purpose  of  administering  such  a  department  in  Illinois, 
should  appeal  to  the  Federal  Government  under  some  like  conditions  as  those  set 
forth  in  this  bill,  and  in  their  rules  and  regulations  should  embody  some  principles 
which  were  not  agreeable  to  the  Federal  control  here,  it  might  be  that  the  Federal 
control  here  would  say,  "We  will  not  give  you  any  money."  might  it  not? 

Dr.  HuMiSTON.  I  do  not  understand  that  the  Federal  Government  has  everything 
-to  say  about  the  expenditure  of  any  money,  except  what  is  appropriated  by  the 
General  Government. 

The  Chairman.  If  you  Avill  follow  me  through  now,  we  will  save  time,  and  you 
can  answer  me  as  broadlv  as  vou  will. 


94  PUBLIC  PROTECTIOISJ'   OF  MATERNITY  AND  INFANCY. 

Dr.  HuMisTON.  I  want  to  answer  you  directly. 

The  Chairman.  If  the  State  of  Illinois  comes  for  its  share  of  money  to  the  Federal 
board,  whatever  it  may  be,  and  presents,  as  provided  in  this  bill,  regulations,  plans, 
etc.,  not  agreeable  to  the  Federal  board,  the  Federal  board  may  refuse  to  give  them 
money,  may  it  not.  up  to  that  point? 

Dr.  HuMiSTON.  It  specifically  says  so. 

The  Chairman.  Then,  the  natural  step  would  be  for  the  Federal  board  to  say,  "We 
must  modify  your  plans  so  and  so,  and  if  you  do  we  will  give  you  the  money."  That 
would  be  natural,  would  it  not? 

Dr.  HuMisTON.  Yes. 

The  Chairman.  Then  the  State  of  Illinois,  if  it  should  take  any  money  from  the 
Federal  Government,  is  obliged,  you  have  admitted,  to  change  its  plans,  and  by  so 
doing  it  may  have  fallen  short  in  its  ideas  of  the  way  to  administer  this  kind  of  work. 

Dr.  HuMiSTON.  Well,  to  separate  those  two 

The  Chairman  (interposing).  Kindly  follow  me. 

Dr.  HuMiSTON.  I  am  trying  to. 

The  Chairman.  I  asked  you,  if,  in  the  expenditui'e  of  money  of  the  Federal  Govern- 
ment, the  State  of  Illinois  would  not  then  be  obliged  to  follow  to  the  letter  the  plans 
set  forth  here  in  Washington,  whether  Illinois  believed  that  they  were  the  best  plans 
or  not? 

Dr.  HuMisTON.  Most  assuredly. 

The  Chairman.  That  is  the  answer.  If  they  operated,  then,  under  this  law,  and 
took  any  money  from  the  Federal  Government,  the  State  of  Illinois  would  have  to 
abandon  any  plan  which  it  thought  was  the  best  plan  in  order  to  get  the  money.  That 
you  will  agree  to.  Now,  if  they  do  that,  why  does  not  the  ruling  of  the  Federal  Gov- 
ernment control  the  entire  outlay  of  the  States  own  appropriation  however  large  in 
the  administration  of  this  work? 

Dr.  Humiston.  In  effect,  that  is  the  way  it  would  work  out.  That  whole  depart- 
ment of  maternity  and  child  welfare  would  be  ruu  in  accordance  with  rules  laid  down 
here,  in  order  to  get  the  money.  They  would  not  have  two  plans  of  spending  their 
own  and  the  Federal  Government's  money.  What  it  would  amount  to  in  effect  would 
be  direction  and  supervision  by  this  bureau  of  all  the  activities  that  had  to  do  with 
this  particular  subject. 

The  Chairman.  It  would  put  the  Federal  Government  in  the  position  of  appro- 
priating, as  Mr.  Hawes  suggested,  §40,000  of  Federal  money  as  against  $2,500,000  of 
State  money,  and  insisting  that  the  Federal  Government  should  control  the  whole 
matter. 

Dr.  Humiston.  It  would  have  that  effect. 

Mr.  Hoch.  Are  you  opposed  or  is  your  association  opposed  to  the  dissemination  of 
information,  either  by  bulletin  or  through  public  health  nurses  or  otherwise,  relative 
to  ]>renatal  care  or  the  care  of  infants,  whether  it  be  by  the  State  government,  the 
Federal  Government,  or  by  the  municipal  government?  As  a  matter  of  principle,  are 
you  opposed  to  the  State  fiurnishing  information  upon  matters  of  that  sort? 

Dr.  Humiston.  No,  sir.  My  association  is  nqt  opposed  to  the  dissemination  of 
information;  in  fact  it  is  quite  actively  engaged  in  the  dissemination  of  such  informa- 
tion; but  not  quite  so  broadly  as  your  question  puts  it,  because  when  you  say  through 
the  State,  National  Government,  municipality,  public-health  centers,  or  otherwise, 
I  can  easily  conceive  of  a  mischievous  sort  of  dissemination  of  information. 

Mr.  Hoch.  ProAdded  it  is  proper  information,  it  is  all  right,  is  it  not? 

Dr.  Humiston.  As  a  doctor,  I  am  asked  again  and  again  the  cpiestion  of  whether  a 
baby  ought  not  to  be  permitted  to  grow  a  little  older  before  another  shall  come  along. 
I  have  no  notion  that  this  bill  provides  for  that  sort  of  instruction,  but  that  sort  of 
question  will  be  asked. 

Mr.  Hoch.  I  am  not  talking  about  any  improper  information.  I  am  talking  about 
proper  information,  whether  given  by  the  doctor  or  whether  it  comes  through  public 
sources  of  information.  I  want  to  get  at  your  fundamental  attitude.  I  want  to  know 
whether,  as  a  matter  of  principle,  doctors  think  that  the  State — and  when  I  say  the 
State,  I  use  the  tenn  in  its  generic  sens  3 — has  any  business  to  to  be  furnishing  informa- 
tion, and  by  that  I  mean  proper  information  with  reference  to  prenatal  care  Or  with 
reference  to  the  care  of  children;  or  should  that  be  left  entirely  to  the  medical  pro- 
fession? 

Dr.  Humiston.  No,  sir;  I  think  that  the  medical  profession  should  do  its  best. 
When  you  say  "proper  information,"  of  course  I  am  in  favor  of  proper  information,  as 
a  medical  man,  and  I  think  all  of  us  are,  whatever  its  source. 

Mr.  Hoch.  You  are  opposed  to  the  Government,  either  State,  municipal,  or  Fed- 
eral, giving  any  information  upon  this  subject,  because  you  are  afraid  they  will  give 
some  improper  information?     Is  that  your  attitude? 


PUBLIC   PROTECTION   OF   MATEENITY  AND   INFANCY.  95 

Dr.  liuMisTON.  Do  I  understand 

Mr.  IIocH.  That  (luestion  is  perfectly  plain.  That  is  certainly  asimplo  question. 
I  want  to  get  at  your  fundamental  attitude  in  regard  to  the  dissemination  of  information 
of  that  sort. 

Dr.  HuMiSToN.  The  Department  of  Public  Health  should  disseminate  information 
that  is  useful  to  the  people,  and  that  information  of  a  medical  nature  should  come 
through  medical  channels.  It  should  be  made  available  to  the  people.  Does  that 
answer  your  question? 

Mr.  IIocH.  Not  entirely.  Do  you  think  that  the  work  being  done  in  New  York 
City,  to  which  reference  has  been  made,  is  a  good  thing  or  a  bad  thing? 

I)r.  HuMisTON.  I  think  it  is  a  good  thing.  If  you  want  to  ask  me  more  particularly, 
however,  al^out  the  specific  activities  of  these  different  agencies,  I  could  answer  you 
better  in  regard  to  the  work  nearer  home,  in  Chicago.  I  think  it  is  quite  similar  to  the 
work  in  New  York. 

Mr.  HocH.  Ijet  us  stick  to  that  question.  If  it  is  a  good  thing  in  New  York  City, 
what  becomes  of  your  argument  that  the  State  or  city  should  not  take  part  in  the 
dissemination  of  this  information  and  in  the  doing  of  this  work? 

Dr.  HuMisTON.  The  question  lies  right  here,  and  I  am  not  taking  issue  with  this 
question  that  New  York  City  can  do  any  of  those  things.  New  York  City  should  do 
those  things  that  are  proper  for  her  to  do,  but  these  are  not  proper  functions  of  the 
Federal  Government. 

Mr.  HocH.  That  is  what  I  want  to  get  at.  I  want  to  know  whether  you  hang  your 
opposition  solely  upon  the  proposition  that  it  is  not  a  function  of  the  Federal  Govern- 
ment, or  that  it  is  not  a  function  of  government  at  all.  It  seems  to  me  that  the  most 
of  your  argutaent  here  has  been  directed  against  the  proposition  of  any  government, 
whether  State,  municipal  or  Federal,  doing  this  work,  and  it  appears  to  me  that  the 
reasons  yoti  have  advanced  in  that  regard  against  Federal  action  would  apply  with 
equal  force,  so  far  as  the  philosophy  of  government  is  concerned,  against  the  work 
being  done  by  any  governmental  agency,  whether,  for  instance,  by  the  city  of  New 
York  or  the  State  of  New  York. 

Dr.  HuMisTON.  As  an  abstract  proposition,  that  applies,  but  this  is  a  concrete  form 
of  government  that  we  are  working  under.  My  objectjion  is  not  to  the  objects  of  this 
bill,  but  to  the  means  which  are  used  to  accomplish  them  through  the  General  Govern- 
ment. It  should  1)0  under  municipal  or  State  departments  of  health  within  certain 
limits.  I  would  place  under  those  departments  not  the  practice  of  medicine  but 
sanitation  and  hygiene.  I  believe  in  doing  all  of  those  things.  I  would  not  leave 
all  of  that  to  the  individual  doctor,  because  the  State  has  a  duty  to  perform  there. 
It  is  a  well-defined  duty. 

Mr.  HocH.  On  proper  activities  in  sanitation  and  hygiene? 

Dr.  HuMisTON.  Yes,  sir. 

Mr.  HocH.  Do  you  think  there  is  anything  to  fear  from  the  State  encroaching  upon 
the  domain  of  the  profession? 

Dr.  HuMiSTON.  Yes.    . 

Mr.  HocH.  You  do  approve  the  activities  of  the  public-health  services  in  some 
lines? 

Dr.  HuMiSTON.  In  some  lines,  but  not  in  all.  We  want  to  cooperate  with  the 
departments  of  pul^lic  health,  but  we  have  to  check  them  up.  Wlien  they  go  to 
practicing  medicine,  we  want  them  checked,  because  the  State  can  not  do  that  nearly 
as  well  as  the  medical  practitioner.  We  object  to  the  State  practicing  medicine, 
but  we  want  to  cooperate  with  the  State  in  matters  of  sanitation  and  hygeine,  and 
instruction  in  maternity  is  very  properly  a  part  of  the  instruction  to  be  given  by  the 
State  department  of  health.  However,  it  is  a  State  function.  That  is  what  I  am 
asking  for  here.     The  details  of  this  we  can  take  care  of  in  om  own  State. 

Mr.  Hawes.  I  think  yoiu"  answers  to  questions  propounded  by  Mr.  Hoch  have 
cleared  up  some  of  the  confusion  in  my  mind.  I  want  to  ask  you  two  questions,  to 
wliich,  1  think,  you  can  answer  "yes"  or  "no."  If  you  can  not,  of  course,  you  can 
extend  your  remarks.  Are  you  in  favor  of  State  and  local  dispensaries  for  the  care 
of  the  sick? 

Dr.  HuMisTON.  No,  sir;  not  for  the  care  of  the  sick. 

Mr.  Hawes.  For  the  care  of  the  sick  who  are  not  financially  able  to  take  care  of 
themselves? 

Dr.  HuMiSTON.  Of  charity  medical  attention;  yes,  sir. 

Mr.  Hawes.  You  are  in  favor  of  public  hospitals,  are  you  not? 

Dr.  HuMisTON.  Yes,  sir;  I  am. 

Mr.  Hawes.  Your  objections  to  this  bilt,  then,  are  two — first,  because  it  is  national 
control  as  against  State  control.     That  is  one  thing. 

Dr.  HuMisTON.  Yes,  sir. 


96  PUBLIC  PROTECTIOIsr   OF   MATERNITY  AND  INFANCY. 

Mr.  Ha  WES.  And,  second,  that,  because  95  per  cent  of  the  questions  involved  in 
maternity  are  hygienic  or  medical  questions,  the  direction  should  be  given  by  com- 
petent physicians.     That  is  your  second  objection? 

Dr.  HuMisTON.  Yes,  sir. 

The  Chairman.  Are  there  any  further  questions,  or  do  you  care  to  enlarge  upon 
any  of  your  answers? 

Dr.  HuMisTON.  I  think  it  is  clear  enough  from  what  I  have  already  said. 

(Thereupon,  the  committee  adjourned  until  to-morrow,  Tuesday,  July  19,  1921, 
at  9.30  o'clock  a.  m.) 

Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Tuesday,  July  19,  1921. 
The  committee  met  at  9.30  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman) 
presiding. 

The  Chairman.  We  will  proceed  with  the  hearings  on  the  Sheppard-Towner  bill. 
Before  calling  any  witness  I  would  like  to  read  a  message  which  was  clearly  intended 
to  be  presented  here  yesterday  by  Dr.  Humiston.  This  message  is  from  the  Civic 
Federation  of  Chicago,  is  signed  by  Douglas  Sutherland,  secretary,  and  reads  as 
follows: 

"Chicago,  III.,  July  18,  1921. 
"Hon.  Samuel  E.  Winslow, 

"Chairman  Committee  on  Interstate  and  Foreign  Commerce, 

" House  of  Representatives ,  Washington,  D.  C. 
"In  appearing  before  your  committee  against  Sheppard-Towner  bill  Dr.  Charles 
E.  Humiston  will  represent  the  Civic  Federation  of  Chicago,  as  well  as  Illinois  State 
Medical  Society.  We  have  opposed  successfully  similar  Illinois  legislation  as  unnec- 
essary and  are  concerned  over  tendency  to  extend  Federal  subsidies  to  local  govern- 
ments as  unsound  fiscal  policy,  leading  to  extravagance  in  local  governments,  demands 
for  increasing  Federal  aid,  and  greater  tax  burdens.  Please  let  Humiston  read  this. " 
The  Chair  will  call  upon  Dr.  George  W.  Kosmak,  of  New  York,  to  present  his  views 
on  the  bill. 

STATEMENT  OF  DR.   GEORGE  W.  KOSMAK,  NEW  YORK  CITY. 

Dr.  Kosmak.  Mr.  Chairman,  I  represent  the  American  Gynecological  Society  as 
a  member  of  its  committee  on  maternal  welfare.  I  am  the  editor  of  the  American 
.lournal  of  Obstetrics  and  Gynecology.  I  have  served  as  attending  surgeon  to  the 
lying-in  hospital  of  the  city  of  New  York  for  16  years.  I  have  devoted  myself  entirely 
to  the  practice  of  obstetrics  and  gynecology. 

Mr.  Chairman,  I  feel  in  contrast  to  the  speaker  who  preceded  me  yesterday,  that  I 
must  begin  my  remarks  with  apologies  rather  than  concluding  them  that  way.  I 
have  not  the  gift  of  oratory  that  Dr.  Humiston  displayed.  I  am  a  practitioner  of 
medicine  and  have  devoted  myself  entirely  along  those  lines,  rather  than  those  of 
sociology  or  of  medical  politics.  It  is  for  that  reason,  Mr.  Chairman  and  gentlemen, 
that  I  want  to  confine  myself  as  much  as  I  possibly  can  to  the  strictly  medical  fea- 
tures of  this  bill  as  they  interest  us  as  physicians,  and  I  trust,  if  you  care  to  question 
me,  that  you  will  please  confine  your  questions  to  that  particular  side  of  the  matter, 
because  I  will  not  be  in  a  position  to  answer  the  financial  or  similar  questions  that 
were  directed  to  the  speaker  on  yesterday. 

Now,  I  might  preface  my  remarks  by  taking  up  the  subject  of  what  has  caused 
the  introduction  of  this  bill.  Is  there  any  real  need?  What  are  the  factors  which 
demand  a  measure  of  this  kind,  or,  in  other  words,  a  recognition  by.  the  National 
Government  of  a  need  for  better  maternity  care?  Now,  like  the  speaker  of  yesterday 
I  have  no  quarrel  with  the  desirability  of  providing  all  mothers  or  prospective  mothers, 
or  those  who  have  been  mothers,  with  better  attention,  at  least  in  many  parts  of  the 
country,  than  they  have  hitherto  received.  The  responsibility  for  providing  such 
attention,  it  seems  to  me,  rests  largely  in  the  hands  of  the  medical  profession,  and  I 
can  not,  as  a  member  of  that  profession,  see  any  necessity  or  desirability  for  turning 
it  over  to  lay  persons.  It  appears  that  the  demand  for  a  measure  of  this  kind  rests 
largely  on  statistics  of  birth  rate,  morbidity,  and  mortality  rates,  which  have  been 
published  by  various  countries,  and  I  beg  to  call  your  attention  to  the  fact  that  in 
comparing  our  United  States  statistics  with  the  statistics  of  foreign  countries,  prewai 
figures  have  been  largely  made  use  of.  For  example,  the  German  figures  are  ofter 
quoted  in  comparison  with  ours,  and  it  is  stated  that  the  mortality  and  morbiditjK 
rates  among  pregnant  women  in  Germany  is  much  less  than  in  the  United  States  a 


PUBLIC  PROTECTION   OF   MATERNITY   AND  INFANCY.  97 

It  is  claimed  that  the  complications  of  pregnancy  of  an  avoidable  nature,  such  as 
convulsions  or  eclampsia,  are  much  less  in  Germany  than  they  are  in  the  United 
States.  The  same  thing  is  claimed  for  Switzerland  and  the  same  thing  is  claimed  for 
the  northern  countries  of  Europe.  I  desire,  however,  to  call  your  attention  to  the 
fact  that  not  only  were  these  statistics  derived  from  prewar  periods  but  they  are 
gathered  in  countries  in  which  the  population  is  of  a  homogenous  character,  in  which 
government  supervision  is  carried  out  to  an  extent  that  would  not  be  tolerated  in  the 
United  States.  Moreover,  were  those  countries  subjected  to  the  same  factors  upon 
which  we  are  compelled  to  base  our  statistics  an  immediate  change  in  the  picture 
would  take  place. 

Referring  again  to  (Germany,  I  also  desire  to  call  attention  to  the  fact  that  during 
the  war,  when  the  women  of  Germany  were  subjected  to  entirely  different  conditions 
as  to  food  supply,  etc..  than  they  were  previous  to  the  war,  the  incidence  of  eflampsia  or 
convuLsions  as  they  are  popularly  called,  immediately  declined,  so  that,  where  during 
pre\ious  years  three  women  out  of  a  definite  number  developed  convulsions,  during 
the  war  only  one  woman  developed  convulsions.  We  must  suppose  that  dunng  this 
particular  ]}eriod  the  \arious  supervisory  functions  of  the  government  certianly  were 
diminished,  as  (lermany  had  conc-entrated  her  entire  attention  upon  winning  the  war, 
an<l  not  ui^on  saving  a  certain  number  of  women  from  developing  eclampsia. 

Now,  I  am  not  bringing  forward  that  jjoint,  not  to  controAert  the  good  opinion  which 
has  been  de\eIo])ed  in  iaxor  of  prenatal  care,  etc.  As  physicians,  we  can  not  deny 
that  prenatal  care  has  succeeded  in  reducing  the  morbidity  and  mortality  in  child- 
birth to  a  large  degree;  but  I  want  to  call  your  attention  to  the  fact  that  there  are  other 
very  important  matters  that  enter  into  the  question,  and  that  it  is  not  fair  for  us  in 
this  country  to  base  our  arguments  on  statistics  that  can  not  be  fairly  or  favorably 
compared  with  statistics  which  undei'  the  stress  of  war  time  and  different  circumstancts 
become  materially  altered. 

Referring  again  to  Germany,  whicli  seems  to  be  the  fountainhead  of  all  that  has 
been  done  in  this  direction,  it  might  be  well  to  consider  just  why  these  restrictive 
and  helpful  measures  were  introduced.  They  were  developed  in  the  early  part  ol 
Bismarck's  regime  as  German  chancellor,  when  he  instituted  the  various  health  an<l 
insurance  measures  which  were  prevalent  throughout  Germany  and  which  found 
their  expression  in  the  so-called  "'Krankenkassen,"  not  for  any  "artruistic  purposes, 
but  simply  to  have  in  his  hands  all  the  knowledge  which  it  was  possible  to  gain  of 
the  economic  condition  of  the  German  working  man.  Through  the  institution  of 
such  "health  '"  measures,  a  firm  grasp  on  the  middle  and  lower  classes  was  obtained, 
the  medical  profession  was  subjected  to  a  process  of  slavery,  and  the  final  result  in 
the  case  of  this' "super-state "  is  known  to  you  all. 

Therefore,  as  a  physician,  I  do  not  believe  that  the  problem  under  discussion  can 
be  solved  by  legislative  enactments,  or  that  the  law  is  a  short  cut  to  reform. 

In  connection  with  the  presentation  of  these  statistics  I  might  call  attention  again 
to  the  large  amount  of  misinformation  which  has  been  spread — I  do  not  know  and  I 
can  not  say  by  what  means— as  a  propaganda  measure  in  favor  of  this  bill.  The 
question  has  been  attacked  by  those  who  favor  the  bill  largely  from  the  sociological 
I  standpoint:,  and  I  regret  to  say  that  the  medical  profession  as'  a  whole  has  not  been 
I  consulted  in  its  construction.  I  am  also  ashamed  to  admit  that  the  medical  profession 
!  has  not  taken  its  proper  stand  in  insisting  upon  being  called  to  enter  its  own  opinions 
in  this  matter.  That,  however,  is  a  question  that  I  do  not  think  you  would  be  in- 
terested to  have  me  dilate  upon  further. 

The  argument  is  usually  made  that  women  are  back  of  this  measure;  that  they  want 
it,  and  want  it  for  their  own  protection.  Now,  we  as  men  can  not  deny  but  that 
women  must  be  given  a  certain  and  a  very  important  position  in  regulating  their  own 
welfare,  be  that  social,  economic,  or  medical,  but  we  would  like  to  suggest  to  women 
that  they  at  least  accept  our  opinion  as  physicians  as  to  measures  that  must  be  at  least 
95  per  cent  medical  in  their  interest,  and  only  5  per  cent  social  or  sociological. 

I  find  that  a,  great  deal  of  the  support  which  has  been  generated  among  organized 
women  in  their  clubs  and  various  other  bodies  has  been  obtained,  I  regret  to  say, 
under  false  pretenses.  The  subject  is  brought  up,  for  example,  in  a  local  women's 
club  by  a  speaker  who  is  thoroughly  interested  and  imbued  with  the  idea  that 
something  of  this  kind  must  go  through;  the  women  are  made  to  believe  that 
something  for  the  benefit  of  their  own  sex  and  of  their  children  should  not  be  denied 
to  them  by  the  men  of  the  Nation,  but  the  more  important  features  connected  with  a 
measure  of  this  kind,  the  carrying  out  of  which  will  contribute  to  its  success,  are  not 
brought  before  them  for  proper  consideration.  In  consequence,  we  have  developed 
during  the  last  year  or  so  a  certain  sentiment  among  women  who  are  opposed  to  this 
measure,  and  which  I  think  you  gentlemen  ought  to  recognize.     That  is  to  say,  not  all 

74654—21 7 


98  PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY. 

the  women  of  this  country  are  in  favor  of  this  bill,  and  I  venture  to  say  that  a  great 
many  of  them  if  they  better  understood  what  was  back  of  it  would  change  their  opinion 
and  withdraw  their  support. 

To  me  as  a  medical  man  the  bill  seems  very  vague  in  everything  but  its  title  and 
the  financial  features  connected  with  it.  I  can  not  for  the  life  of  me  understand  why 
a  measure  which  is  so  largely  medical  in  its  aspects  should  be  placed  under  the  domi- 
nation of  a  bureau  which  is  not  concerned  with  medicine  as  a  science  at  all.  Medicine 
is  not  an  industry;  it  is  a  science — at  least,  we  are  trying  to  make  it  so.  It  has  been  an 
art  for  a  great  many  years,  but  when  you  consider  the  advances  which  are  being  made 
in  medical  research,  you  must  realize  that  we  are  gradually  placing  medicine  on  a 
scientific  basis,  and  it  is  not,  I  beg  to  inform  you  again,  an  industry. 

We  doubtless  feel  that  a  great  deal  has  been  done  through  channels  that  are  now 
working  to  secure  better  maternity  care.  A  great  deal  has  been  done  to  reduce  mor- 
bidity and  mortality  among  pregnant  women,  and  we  believe  that  this  has  been  done 
largely  through  local  efforts.  It  has  been  done  through  the  interest  which  is  generated 
in  local  communities  to  better  their  immediate  surroundings  without  external  assist- 
ance, either  in  the  form  of  money  or  in  the  form  of  dictation. 

Undoubtedly  in  the  development  of  a  scheme  for  improved  maternity  care  a  bill 
of  this  kind  will  do  some  good.  I  am  not  narrow-mined  enough  to  deny  that  some 
benefit  may  be  secured  from  this  measure,  but  is  that  benefit  sufficient  to  warrant 
surroimding  the  particular  matter  in  which  we  are  interested  with  what  I  regard  as 
unfortunate  features?  They  are  unfortunate,  I  believe,  because  they  will  restrict 
the  development  of  this  particular  branch  of  medicine.  A  strictly  medical  matter  j 
which  is  turned  over  in  large  part  to  laymen  to  execute  will  soon  become  overburdened  | 
with  the  lay  features  connected  with  such  supervision.  That  has  been  very  well 
demonstrated  to  me  in  my  personal  experience  with  an  association  in  New  York 
which  has  concerned  itself  with  providing  better  maternity  care  for  women  who  are 
imable  to  provide  it  through  lack  of  financial  means.  This  organization  from  small 
beginnings  has  grown  to  be  a  very  important  factor  in  medicine  in  New  York,  in 
hospital  medicine.  It  has  done  a  great  deal  to  improve  the  prenatal  state  of  many 
women  who  would  not  otherwise  come  imder  the  benefits  of  siich  knowledge.  I  have 
foimd,  however,  within  the  last  year  or  two  that  over  one-third  of  the  expenses  of  that 
association  went  into  the  collection  of  most  elaborate  statistics  based  on  the  knowledge 
that  has  been  gained  by  the  visiting  nurses  and  by  the  doctors  who  were  connected 
with  this  organization.  After  this  statistical  knowledge  was  obtained,  which  was 
undoubtedly  of  great  value,  a  succeeding  budget  contained  a  request  for  exactly  the 
same  amount  of  money  to  keep  this  up.  In  other  words,  the  strictly  medical  benefits 
derived  from  the  work  of  this  organization  were  becoming  gradually  subordinated  to 
purely  sociological  features,  to  such  an  extent  that  it  was  deemed  necessary  to  close 
two  of  the  substations  in  this  association  in  order  to  provide  possible  funds  for  tlie 
furthering  of  the  sociological  investigations. 

Now,  gentlemen,  we  have  arrived  at  the  stage,  it  seems  to  me,  where  economy 
should  dictate  our  expenditures  in  medical  charities,  and  we  should  not  be  asked  to 
give  up  to  sociological  studies  money  which  is  needed  in  a  more  practical  way  to  con- 
tribute to  the  comfort  of  these  women  whom  we  seek  to  aid.  There  are  plenty  of 
statistics.  There  is  no  need  of  going  any  further.  We  know,  we  acknowledge,  it  iS 
an  accepted  fact,  that  proper  supervision  of  the  pregnant  woman  will  reduce  her  chances 
of  getting  into  trouble.  Now  why  spend  more  money  in  elaborating  that  particular 
thing? 

I  feel  that  the  example  which  I  have  quoted  will  be  reflected  in  the  larger  work 
which  it  is  proposed  to  do  through  the  medium  of  a  department  contemplated  in  the 
bill,  which  will  become  national  in  scope.  I  feel,  gentlemen,  that  the  work  relegated 
to  such  a  bureau  or  department  will  become  burdened  with  a  mass  of  sociological 
experiments  that  will  interfere  with  the  carrying  out  of  the  essential  medical  provi- 
sions of  a  measure  that  it  may  be,  and  probably  is,  extremely  essential. 

Mr.  Parker.  Is  that  society  that  you  just  mentioned  in  New  York  a  private  charity 
or  a  public  department? 

Dr.  KosMAK.  It  is  a  private  organization.   . 
Mr.  Parker.  Supported  by  contributions? 

Dr.  KosMAK.  Yes;  and  which  I  regret  to  say  supports  the  Sheppard-Towuer 
measure  because  of  the  misunderstanding  to  which  I  have  alluded  in  the  beginning 
of  my  remarks.  So  that  I,  as  one  of  the  medical  directors,  am  speaking  against  my 
own  lay  associates  in  this  matter.  It  is  very  difficult  for  a  medical  man  to  confine 
himself  to  the  strictly  medical  features  of  a  measure  of  this  kind  in  addressing  a  lay 
audience,  because  they  are  of  such  a  character  that  it  is  difficult  to  interpret  them  in 
a  proper  way,  and  you  must  pardon  me,  therefore,  if,  notwithstanding  what  I  said  at  i 
the  beginning,  I  do  come  back  to  those  aspects  of  the  bill  which  are  more  or  less  lay 

i 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  99 

in  character.  Aiul  I  want  tf)  refer  in  tliiw  connection  to  the  queHtion  of  centralized 
administration  in  administerinf;  a  movement  of  tliiw  Hort.  Ah  physicianH  we  l)elieve 
that  this  is  entirely  wrong.  We  Ijase  our  objections  on  what  has  been  done  through 
the  medium  of  otlier  centralized  agencies  whic-h  we  think  have  been  a  bar  to  medical 
progress. 

We  believe  that  these  measures  can  be  carried  out  much  more  satisfactorily  through 
the  medium  of  State  agencies,  or,  ])erhap8  l)etter  yet,  local  organizations  directed 
through  State  agencies,  than  they  can  through  any  centralized  Federal  t)ureau  which 
will  develop  a  hold  on  the  execution  of  such  measures  l)y  local  agencies  that  it  will  l)e 
very,  very  ditiicult  indeed  to  control. 

Gentlemen,  in  connection  with  the  centralized  control  of  medical  matters  I  might 
call  your  attention  to  the  working  of  the  narcotic  drug  commission  in  the  State  oi 
New  York.  In  response  to  a  demand  fathered  largely  l)y  lay  organizations,  a  com- 
mission was  appointed  l)y  the  governor  to  take  over  the  entire  question  of  control  of 
the  narcotic  (h-ug  situation  in  the  State  of  New  York.  A  very  elal)orate  connni.ssion 
of  seven  members  and  any  numl)er  of  clerks,  etc.,  was  organized  and  functioned  for  a 
period,  1  l)elieve.  of  less  than  two  years,  because  it  was  deemed  that  their  functions 
overlajjped  or  interfered  to  a  large  extent  with  the  Federal  laws  in  the  matter,  and 
also  prevented  the  physician  who  practiced  medicine  legitimately  from  serving  the 
best  interests  of  his  patients.  It  was  entirely  useless  because  there  was  no  need  for 
any  further  restrictive  legislation  in  this  Held.  The  doctor  was  compelled  to  register  , 
in  addition  to  being  registered  under  the  Harrison  act,  in  the  narcotic  drug  depart- 
ment of  the  State  of  New  York.  He  was  prevented  from  prescribing,  even  if  his 
judgment  dictated  otherwise,  more  than  a  certain  amount  of  opium  for  the  relief  of 
pain  or  for  other  conditions  that  might  call  for  it;  and  in  consequence  the  patients 
suffered,  because  many  physicians  simply  rebelled  at  being  compelled  to  observe 
such  restrictions  after  the  State  had  given  them  a  license  to  practice. 

I  might  call  your  attention  to  the  .fact,  gentlemen,  that  the  medical  men  of  the 
country  who  busy  themselves  with  obstetrics,  that  part  of  medicine  wliich  is  directly 
concerned  with  this  measure,  are  almost  to  a  unit  opposed  to  this  measure  as  it  stands 
at  the  present  time.  I  need  only  call  your  attention  to  the  resolutions  passed  at  the 
June  meeting  of  the  American  Gynecological  Society.  This  is  the  representative 
organization  of  this  particular  specialty  in  America,  and  disapproved  of  any  form  of 
legislation  of  tliis  character  administered  through  a  minor  governmental  bureau,  but 
in  which  resolution  it  was  agreed  that  if  tliis  sort  of  thing  was  desired  it  should  be 
administered  through  a  national  department  of  health,  or  similar  organization,  without 
the  financial  and  restrictive  features  proposed  in  the  Sheppard-Towner  bill. 

Mr.  Towner.  Will  you  put  that  statement  in  the  record,  doctor? 

Dr.  KosMAK.  I  will  be  glad  to  do  so.  Perhaps,  Mr.  Chairman,  it  might  be  well 
for  me  to  read  this.     It  is  very  brief: 

•'The  American  Gynecological  Society,  at  its  forty-sixth  annual  meeting  held 
June  2  to  4,  1921,  took  the  following  action  regarding  the  bill  for  the  protection  of 
mothers  and  infants  commonly  known  as  the  Sheppard-Towner  bill. 

"This  action  of  the  society  was  taken,  almost  unanimously,  after  careful  considera- 
tion of  a  report  of  its  committee  on  maternal  welfare  acting  jointly  with  a  similar 
committee  of  the  American  Child  Hygiene  Association. 

"This  society  wishes  definitely  to  state  its  position  for  the  information  of  the  medical 
profession  and  others  who  are  interested  in  this  legislative  program. 

"1.  The  committee  is  in  thorough  acr'ord  with  the  ends  which  this  bill  seeks  to  at- 
tain, namely,  the  protection  of  the  health  of  mothers  and  infants. 

•'2.  We  indorse  the  coordination  of  all  health  activities  under  one  head.  We  con- 
sider the  protection  of  mothers  and  infants  to  be  a  health  measure  of  paramount  im- 
portance to  the  individual  and  the  State. 

•'3.  We  oppose  in  principle  the  control  of  health  measures  by  nonmedical  individ- 
uals or  boards. 

■'4.  We  believe  in  the  local  control  of  health  activities  as  distinguished  from  Federal. 
We  ap])rove  and  indorse  the  idea  of  propaganda  and  investigation  emanating  from  the 
Federal  Government. 

•'5.  We  do  not  indorse  the  Sheppard-Towner  bill  in  its  present  form  because  it  does 
not  conform  to  the  above  principles  and  because  it  embodies  the  questional)le  j^lan 
of  subsidizing  State  health  activities. 

"6.  We  indorse  the  project  of  establishing  a  national  department  of  health. 

■'George  Gray  Ward.  President . 
■'Arthur  H.  Curtls.  Sicrciari/. 
I  "'George  W.  Kosmak, 

■'Fred  J.  Taussig, 
■'  Fred  L.  Adair, 

■'  Chairman  of  committee.^ ' 


100  PUBLIC   PEOTECTIOlir   OF   MATERNITY  AND  INFANCY. 

There  is  one  question  that  has  been  brought  to  the  fore  constantly  in  connection 
with  this  bill,  and  that  is  the  supervision  or  the  actual  carrying  out  of  the  features 
of  this  measure  by  nonmedical  persons  in  the  form  of  nurses'  organizations.  Now, 
just  as  Dr  Humiston  stated  yesterday,  I  as  a  physician  desire  to  acknowledge  my 
extreme  debt  to  the  nursing  profession — and  I  want  to  call  it  a  profession — for  what 
nurses  have  done  as  the  handmaidens  of  medicine  I  think  I  can  safely  say  that 
medicine  without  nursing  wouid  go  back  100  years  in  the  march  of  progress,  but  we 
feel  that  wha^t  has  been  done  in  developing  the  nursing  profession  has  been  done 
entirely  through  the  efforts  of  the  medical  profession,  and  I  am  sure  it  is  in  the  mind 
of  every  medical  man  that  nursing  shall  be  developed  as  an  accessory  to  medicine 
and  not  as  a  competitor. 

Measures  of  this  kind  which  throw  the  responsibility  of  deciding  certain  important 
things  connected  with  the  most  critical  period  of  a  woman 's  life  into  the  hands  of  nurses 
who,  under  the  conditions,  must  be  more  or  less  supervised,  must  depend  on  their 
own  resources,  is  a  great  mistake. 

We  feel,  moreover,  that  turning  over  such  important  matters  into  the  hands  of  what 
we  still  consider  lay  people,  will  act  to  the  discredit  of  the  medical  profession  and  also 
as  a  bar  to  its  development.  Now,  gentlemen,  let  me  inform  you  that  in  this  country 
with  its  population,  I  believe,  as  stated  in  the  last  censiis,  of  somewhat  over  100,000,000 
people,  there  are  scarcely  150,000  physicians.  If  by  legislative  enactment  you  are 
going  to  turn  over  an  important  part  of  their  work  into  the  hands  of  nurses,  into  the 
hands  of  doctors  who  are  employed  by  the  State,  you  will  at  once  interpose  a  stumbling 
block  to  the  progress  of  medicine,  because  young  men  will  not  compete  under  those 
circumstances  with  trained  nurses.  Our  medical  schools  are  now  insufficient  in  num- 
ber; many  of  them  are  insufficient  in  their  equipment  to  produce  the  number  of 
physicians  that  are  needed  to  take  care  of  the  health  of  this  Nation,  and  unless  the 
situation  is  improved  in  this  respect,  unless  we  make  medicine  more  attractive  to  our 
youiig  men,  we  will  interfere  with  the  accession  of  recruits  to  this  very  important 
profession. 

Mr.  Johnson.  Mr.  Chairman,  is  it  the  purpose  of  the  commiittee  to  allow  the  gentle- 
men to  conclude  before  he  answers  the  questions? 

The  Chairman.  He  may  suit  himself  in  that  regard. 

Dr.  KosMAK.  I  would  rather  conclude,  Mr.  Chairman. 

Now,  gentlemen,  I  regret  very  much  to  state — and  perhaps  I  will  be  contradicted, 
because  this  is  a  matter  entirely  of  personal  experience — that  the  nursing  profession 
is  undergoing  a  revolution  which  we  as  medical  men  find  it  very  difficult  to  con- 
trovert. We  are  more  than  troubled  in  our  hospitals  now  by  the  lack  of  trained 
nurses.  We  can  not  get  a  sufficient  number  of  young  women  to  take  the  preliminary 
courses  which  will  fit  them  for  this  profession,  and  we  are  very  much  nonplussed  to 
know  the  reason  for  this  lack  of  young  women  willing  to  take  up  something  for  which 
by  nature  they  are  particularly  suited,  when  the  conditions  have  improved  rather 
than  otherwise  in  so  far  as  their  welfare  is  concerned.  We  find  one  reason  in  the  fact 
that  women  find  it  more  agreeable  to  engage  in  occupations  that  limit  their  worl-ing 
hours  to  eight  a  day.  And  the  bill,  under  discussion  would  open  up  thousands  of 
positions  of  this  kind.  In  other  words,  nurses  are  gradually  becoming  imbued  with 
the  idea  of  a  restriction  in  the  number  of  working  hours  with  a  maximum  amount  of 
pay  that  is  now  pervading  a  large  section  of  our  population,  and  we  as  physicians 
feel  that  once  a  nurse  subjects  herself  to  labor-union  methods — I  am  speaking  in  a 
general  way — she  at  once  departs  from  the  high  standing  which  we  have  accorded  her. 

Now,  I  might  ask  you  gentlemen  what  would  happen  if  the  doctors  as  a  body  should 
attempt  to  umonize  their  professional  activities  and  say,  as  the  nurses  are  doing  now. 
''AVe  will  not  work  more  than  8  hours  a  day.  we  will  not  work  more  than  12  hours  a 
day?"  We  are  on  the  job  24  hours  a  day  at  the  present  time,  and  I  doubt  whether 
the  majority  of  nurses  are  or  want  to  be. 

Just  a  word  in  conclusion,  and  then  I  would  be  very  glad,  Mr.  Chairman,  to  answer 
as  best  I  can  the  questions  put  to  me  bj^  the  members  of  the  committee.  As  a  medical 
man  who  has  been  in  practical  touch  with  the  obstetric  situation  through  the  medium 
of  probably  the  largest  maternity  ser\'ice  in  the  United  States,  I  feel  that  1  am  com 
petent  to  speak  on  this  subject  and  to  allow  my  thoughts  to  be  dictated  by  practical 
knowledge,  rather  than  by  theory.  I  say  that,  because  it  seems  to  me,  as  it  has 
seemed  to  a  great  many  of  my  associates,  that  the  heart  rather  than  the  head  has 
dictated  welfare  measures  of  this  kind,  and  while  that  is  a  very  desirable  form  ol 
propaganda,  I  think  that  we  ought  not  to  give  our  entire  attention  to  that  phase  of  it. 
I  l>elieve  that  in  providing  any  means  which  will  benefit  the  health  of  our  mothere 
we  should  take  into  consideration  the  strictly  practical  features  of  a  measure.  Ir 
other  words,  if  we  put  over  a  Inll  of  this  kind,  will  it  work?    Will  it  do  anything  tc 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  101 

better  the  present  condition  which  we  as  medical  men  have  to  acknowledge  in  Jiot 
perfect  but  which  we  are  trying  to  do  the  best  we  can  to  improve. 

I  am  very  thankful,  Mr.  Chairman,  to  have  had  the  opportunity  of  presenting 
these  few  remarks. 

The  Chaikman.   I  think,  Doctor,  that  Mr.  Johnson  wants  to  ask  you  a  rjuestion. 

Mr.  JoHN.soN.   Xo:  1  will  forego  my  (piestions  now. 

The  ('}iAii{MA.\.  Does  any  member  of  the  committee  desire  to  ask  any  (|ue8tions? 

Mr.  Nkwton.  Doctor,  you  mentioned  taking  issue  with  some  of  the  comparisons 
made  by  Dr.  leaker  in  reference  to  the  mortality  rates  in  Europe  as  compared  with 
those  in  this  country.  Do  you  take  issue  with  the  figures?  Do  you  claim  that  they 
are  not  correct,  or  do  you  claim  that  they  are  not  a  fair  basis  of  comparison? 

Dr.  KosMAK.  I  stated  very  distinctly,  Mr.  Newton,  that  I  did  not  believe  these 
figures  were  a  fair  basis  of  comparison.  I  can  not  take  issue  wdth  the  figures.  They 
are  printed  in  black  and  white.  But  you  know  you  can  do  most  anything  you  like 
with  figures. 

Mr.  Newton.  Well,  some  people  can.  I  never  was  able  to  do  very  much  with  them. 
[Laughter.  | 

Dr.  KosMAK.  I  never  was,  either. 

Mr.  Newton.  Now,  you  take  the  figures,  the  comparisons  that  you  ga\e  letween 
Europe  and  America.  As  I  gathered  from  your  testimony,  you  said  that  the  European 
figures  were  taken  before  the  war.     Is  that  correct? 

Dr.  KosMAK.  I  said,  Avith  the  exception,  I  believed,  of  England.  England  has 
some  figures  that  have  been  taken  since  the  war. 

Mr.  Newton.  And  that  they  were  compared  with  American  figures  during  the  war? 

Dr.  KosMAK.  They  were  compared  with  all  American  figures,  both  before  and 
during  the  war.     I  think  we  have  very  few  figures  taken  during  the  war. 

Mr.  Newton.  Of  course,  then,  this  country  was  not  affected  by  war  conditions  as 
jcertain  European  countries  were,  and  it  would  strike  me  as  a  layman  that  that  would 
be  a  fair  comparison,  to  take  the  Eueopean  data  preceding  the  war,  unaffected  by  v.  ar 
conditions,  and  compare  that  with  conditions  in  America  preceding  the  war  and 
during  the  war.  That  is  the  way  it  would  strike  me.  Now,  do  you  take  issue  with 
that  comparison? 

Dr.  KosMAK.  May  I  be  allowed  to  answer  that  question  a  little  more  in  detail?  I 
believe  that  if  figures  could  be  taken  in  this  country  to-day  they  woiild  show  an 
improvement  over  those  that  were  collected  before  the  war.  In  other  words,  I  think 
it  was  in  the  year  1913  that  we  were  put  seventeenth  in  the  list  of  nations  as  regards 
morbidity  and  mortality  from  childbirth.  I  am  quite  certain  that  if  figures  were 
available  to-day  we  would  not  occupy  that  position,  because  I  know  that  conditions 
have  improved  in  those  six  years. 

Mr.  Newton.  That  is,  conditions  have  improved  in  America? 

Dr.  KosMAK.,  Yes,  sir. 

Mr.  Newton.  But,  on  the  other  hand,  conditions  have  gone  the  other  way  in 
Europe? 

Dr.  KosMAK.  Yes. 

Mr.  Newton.  So  that  would  hardly  be  a  fair  comparison,  would  it? 

Dr.  KosMAK.  It  would  not. 

Mr.  Newton.  So  that,  so  far  as  figures  are  available,  does  it  not  seem  to  jou  that 
prewar  figures  in  Eui'ope  are  more  comparable  with  present  and  prewar  figures  in 
America  than  what  the  present  figures  would  be  as  compared  -with  present  American 
figures? 

Dr.  KosMAK.  Yes;  I  think  so. 

Mr.  Newton.  So  that  Dr.  Baker  gave  the  very  fairest  comparison  that  could  be 
given? 

Dr.  KosMAK.  Now  that  Dr.  Baker's  name  has  been  mentioned,  will  you  permit  me 
to  call  attention  to  the  fact  that  the  very  great  improvement  in  prenatal  statistics 
that  has  been  brought  about  in  the  city  of  New  York  has  been  brought  about  largely 
through  Dr.  Baker's  bureau  of  child  hygiene,  developed  as  a  purely  local  organization 
without  the  aid  or  dictation  of  State  or  Federal  agencies?  I  think  that  Dr.  Baker's 
statement,  which  I  did  not  hear  on  this  occasion,  but  which  I  have  heard  elsewhere, 
is  the  best  argument  that  I  might  personally  bring  forward  as  an  objection  to  this 
measure,  because  the  community  spirit  in  New  York  has  done  exactly  what  we  would 
like  to  see  done  all  over  this  country  and  done  without  outside  assistance. 

^fr.  Newton.  You  and  I  are  in  entire  accord  on  that.  You  agree,  then,  that  the 
work  as  conducted  by  the  local  authorities  there  in  New  York  has  been  efficiently 
•  administered  and  that  it  is  a  ^\-ise  policy  for  the  community  to  carry  out? 

Dr.  KosMAK.  Yes;  and  it  has  been  largely  done,  I  might  say,  through  strictly 
medical  agencies.     Dr.  Baker  is  a  physician  and  practically  all — in  ii^ct,  I  might  say 


102  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

all — the  people  of  the  New  York  department  of  health  whose  work  brings  them  into 
contact  with  this  situation  are  medical  men,  and  most  of  them  have  been  in  active 
])ractice. 

Mr.  Newton.  Now,  then,  according  to  the  figures  given  by  her,  the  death  rate 
among  babies  was  reduced  from  144  out  of  every  1,000  births  to  85,  which,  of  course, 
speaks  for  itself.  Now  there  are  a  good  many  communities  that  have  not  taken  up 
that  work  as  New  York  ( lity  has.  Certainly  we  are  all  interested  in  encouraging  those 
communities  that  have  taken  up  this  work,  are  we  not? 

Dr.  KosMAK.  Yes,  sir. 

Mr.  Newton.  Now,  if  I  understand  the  purpose  of  this  bill,  the  Federal  Govern- 
ment is  asked  to  make  certain  appropriations  with  the  primary  purpose  of  encoiu'ag- 
ing  the  States,  then  the  localities,  to  take  up  this  kind  of  work.  Do  you  take  the  posi- 
tion that  the  Federal  Government  should  in  no  sense  encourage  work  of  this  kind  by 
appropriating  any  money  therefor? 

Dr.  KosMAK.  Personally  I  would  object  to  that  method  of  encouragement. 

Mr.  Newton.  Why? 

Dr.  KosMAK.  I  do  not  believe  that  the  mere  appropriation  of  funds,  or  that  the 
imposition  of  rules  and  regulations  on  local  developments  of  this  kind  will  forward 
the  cause  in  any  way. 

Mr.  Newton.  Of  course  that  is  a  detail.  That  is  with  reference  to  the  rules  and 
regulations.  The  main  question  goes  to  whether  or  not  the  Federal  Government  in 
your  judgment  is  warranted  in  expending  any  money  for  the  encouragement  of  this 
kind  of  work  in  the  community. 

Dr.  Ko.'^MAK.  Not  locally.  I  do  not  believe  that  any  50-50  arrangement  is  going 
to  work  out.  I  think  that  the  function  of  the  P'ederal  Government  in  a  case  of  this 
kind  should  be  largely  advisory  in  character.  I  do  not  see  why  a  similar  arrangement 
can  not  be  developed  here  as  has  been  developed  in  other  departments  of  the  Gov- 
ernment where  no  direct  financial  appropriations  are  made,  where  no  direct  super- 
visory control  is  exercised  by  the  central  authority. 

Mr.  Newton.  Now  we  are  a  Nation,  and  the  Nation  itself  has  a  vital  interest,  it 
seems  to  me,  in  every  mother  and  in  every  child,  because  it  is  as  a  Nation  that  we  must 
meet  and  compete  with  the  nations  of  the  world.  We  have  got  to  take  into  considera- 
tion our  producing  power  and  man  power.  It  is  not  only  a  local  question,  a  State 
question,  but  it  seems  to  me  that  it  is  in  itself  a  national  question.  Now  here  is  the 
Federal  Government  down  here  at  Washington  that  sees  a  number  of  States  wholly 
neglectful  of  this  qiiestion;  the  very  fact  that  there  are  certain  States  that  have  no 
reliable  figures  as  to  births  is  evidence  of  that  fact.  Now,  with  that  problem  facing 
the  Nation,  with  its  own  interest  as  a, Nation  in  the  life  of  its  individuals,  you  main- 
tain then  that  the  Nation  ought  not  to  encourage  in  these  communities,  by  the  ap- 
propriation of  money,  the  reducing  of  the  death  rate  both  among  the  mothers  and 
the  babies? 

Dr.  KosMAK.  Mr.  Newton,  I  maintain  nothing  of  the  kind.  I  believe  that  the 
Federal  Government  has  a  very  important  function  in  this  matter,  but  I  do  not  believe 
that  that  important  function  can  be  exercised  through  the  medium  of  a  minor  depart- 
mental bureau.  If  this  question  is  important  enough,  gentlemen,  to  demand  the 
attention  of  this  Government,  then  let  it  be  administered  in  a  large  way,  through  a 
national  department  of  health  or  similar  organization,  with  a  Cabinet  officer  at  its 
head,  which  will  at  once  give  dignity  to  the  movement  and  not  detract  from  it. 

Mr.  Newton.  Well,  now,  \vould  you  favor  doing  this  work,  the  administrative 
detail,  through  a  department  of  public  health? 

Dr.  KosMAK.  That  would  not  be  necessary,  Mr.  Newton.  The  larger  questions  of 
advice  could  be  given  through  the  medium  of  a  national  department  of  health  without 
interfering  in  any  way  with  the  local  situation;  just  as  is  being  done  now  in  other 
departments. 

Mr.  Newton.  You  would  restrict  the  activities  of  the  Public  Health  Department 
purely  to  that  of  giving  advice  and  not  in  any  way  to  the  expenditure  of  money  itself 
in  the  different  communities? 

Dr.  KosMAK.  You  mean  on  a  50-50  basis? 

Mr.  Newton.  Or  any  basis — a  100  per  cent  basis. 

Dr.  KosMAK.  Well,  a  100  per  cent  basis  I  could  not  object  to,  no;  because  that, 
I  think,  introduces  an  entirely  different  question. 

Mr.  Newton.  That  is  what  I  was  getting  at,  whether  you  were  opposed  to  the  Federal 
Government  doing  anything  or  whether  you  were  opposed  to  their  going  in  jointly 
with  the  States  and  doing  the  work. 

Dr.  KosMAK.  I  am  opposed  to  any  joint  action  in  the  sense  of  a  joint  financial  I 
support,  because  I  do  not  believe  that  it  will  relieve  the  situation.  I  do  not  see  how  ' 
we  are  going  to  better  it  in  the  particular  way  that  is  advocated  in  this  bill,  because  if 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  103 

yon  will  read  it  you  will  seo  tliat  the  entire  application  of  the  matter  is  left  in  the  hand? 
of  lay  persons.  lar<j:oly  in  the  hands  of  visiting  nnrsea  who  are  controlled  indirectly,  J 
might  say,  thnniiih  the  Children's  Bureau  at  Washin,<i:ton.  Now  I  might  say  that  I 
question  very  much  wh(>tlier  many  of  our  States  would  tolerate  that.  States  in  the 
Far  West  certainly  have  entirely  differcMit  conditions  to  meet  than  those  in  the  East. 
New  York  State.  I  am  sure,  would  not  l)e  greatly  benefited  by  an  apjiropriation  of 
$10,000  or  $100,000  for  this  work,  but  I  feel  convinced  that  Nevada  would  be.  but 
Nevada  may  not  !>(>  able  to  raise  that  amount  of  money:  therefore  Nevada  goes  without 
the  benefits  that  are  ]>ut  down  in  this  act. 

Mr.  Newton.  But  don't  you  think  that  New  York  State  would  be  immensely  bene- 
fited by  Nevada  or  any  other  three  or  four  States  that  for  the  purposes  of  illustration 
we  will  assume  are  now  neglecting  these  things,  getting  their  work  up  on  a  par  ■\\-ith 
that  of  New  York?  Do  you  not  think  that  New  York  as  a  member  of  the  Union  would 
benefit  immensely  from  that? 

Dr.  Ko.SMAK.   Indirectly,  I  think  they  would. 

Mr.  Newton.  Now,  getting  back  to  this  question  of  the  department  of  public  health, 
then,  I  take  it  that  vriih  a  department  of  public  health,  which  Congress  would  appro- 
priate money  for  and  they  would  expend  it  themselves  in  the  community,  you  would 
favor  that? 

Dr.  KosMAK.  I  would  favor  that  in  preference  to  this,  because  I  feel  convinced 
that  the  administration  of  an  act  carried  out  through  a  national  department  of  health 
would  be  placed  in  different  hands.  It  would  not  be  carried  out  through  the  medium 
of  a  lay  bodv;  just  as  the  health  activities  of  the  Government  now  are  carried  on 
through  medical  men  and  not  through  lay  persons. 

Mr.  Newton.  Y^ou  say  you  would  favor  it  in  preference  to  this.  Do  you  mean  that 
you  would  not  favor  it  otherwise,  or  if  we  are  going  to  have  something,  you  would 
prefer  that  in  preference  to  this? 

Dr.  KosMAK.  I  would  not  favor  this;  no.  I  would  favor  the  national  department  of 
health. 

Mr.  Newton.  But  you  do  not  believe  even  in  a  national  department  of  health  doing 
this  work  in  the  States  and  in  the  communities? 

Dr.  KosMAK.  Not  by  this  means;  no. 

Mr.  Newton.  Do  you  by  any  means?  *• 

Dr.  KosMAK.  No. 

Mr.  Newton.  You  would  favor  that? 

Dr.  KosMAK.  Yes.  I  might  say  that  a  national  department  of  health  would  not 
attempt  to  carry  out  the  work  in  this  manner.  They  would  resort  to  other  means  to  do 
it,  just  as  they  have  done  in  the  past. 

I  might  say  that  the  Public  Health  Service  is  at  the  present  time  doing  work  of  this 
character  in  another  field.  They  are  meeting  certain  local  problems  with  the  idea  of 
developing  the' local  agencies  so  that  in  time  they  will  take  care  of  themselves.  But 
they  do  not  say,  "We  will  give  you  $1  for  every  dollar  that  you  collect."  They  do  not 
go  at  it  in  that  wav . 

Mr.  Newton.  That  is  all  I  have  to  ask. 

Mr.  Cooper.  Doctor,  in  section  4  you  will  find  this  proviso: 

"That  in  any  State  having  a  child- welfare  or  child-hygiene  division  in  its  State 
agency  of  health,  the  said  State  agency  of  health  shall  administer  the  provisions  of  this 
act  through  such  divisions." 

What  have  you  got  to  say  about  that? 

Dr.  KosMAK.  Well,  I  niight  call  your  attention,  Mr.  Cooper,  to  certain  succeeding 
paragraphs.  I  must  say  that  I  am  not  quite  familiar  with  the  amended  bill.  This 
bill  has  undergone  so  many  amendments  that  we  outside  of  Washington  have  not 
been  able  to  keep  track  of  them,  but  it  seems  to  me  that  elsewhere  there  is  a  direct 
statement  to  the  effect  that  such  sums  shall  only  be  appropriated  provided  these  regu- 
lations meet  with  the  approval  of  the  Children's  Bureau. 

The  Chairman.  That  is  section  8,  Doctor. 

Mr.  Cooper.  But  it  does  say  that  the  State  agency  shall  administer  the  provisions 
of  this  act,  does  it  not? 

Dr.  KosMAK.  Yes;  that  is  very  true,  but  that  is  immediately  controverted  in 
another  section  by  restrictive  paragraphs. 

Mr.  Cooper.  What  special  restrictive  paragraphs? 

Dr.  KosMAK.  I  would  refer  you  to  section  8,  which  reads  as  follows: 

"That  any  State  desiring  to  avail  itself  of  the  benefits  of  this  act  shall,  by  its  agency 
described  in  section  4,  submit  to  the  Children's  Bureau  for  its  approval  of  detailed 
plans  for  carrying  out  the  provisions  of  this  act." 

It  seems  to  me  that  is  very  plain.     Then  it  continues: 


104  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

"These  plans  shall  include  the  provisions  to  be  made  in  the  State  for  the  adminis- 
tration of  the  act,  the  provision  of  instruction  in  the  hygiene  of  maternity  and  infancy 
through  public  health  nurses,  consultation  centers,  and  other  suitable  methods." 

That  is  very  distinctly  stated,  I  think. 

Mr.  Cooper.  That  is  all,  Mr.  Chairman. 

Mr.  HocH.  You  have  spoken  forcibly,  Doctor,  against  permitting  any  instruction 
on  matters  of  this  sort  being  given  by  lay  persons.  Do  you  regard  the  work  done  in 
New  York  City  as  work  done  solely  by  medical  persons? 

Dr.  KosMAK.  I  beg  to  call  your  attention  to  the  fact  that  I  said  not  done,  becau  e 
we  have  to  have  an  immense  amount  of  work  done  by  lay  persons.  We  can  not  avoid 
that,  but  the  supervision  and  direction  is  in  the  hands  of  medical  persons,  and  this 
act  does  not,  as  near  as  I  can  make  it  out,  contemplate  such  supervision,  because  it 
puts  even  the  medical  authorities  of  the  State,  which  may  be  delegated  to  carry  out 
this  act,  under  a  lay  board. 

Mr.  HocH.  Do  you  regard  the  work  in  New  York  City  as  in  any  sense  contrary  to 
the  principles  you  have  suggested  here?  Is  it  done  solely  by  doctors,  or  is  it  done  as 
a  matter  of  fact  very  largely  by  others  who  are  not  doctors? 

Dr.  KosMAK.  It  is  directed  by  doctors.  The  actual  visiting  around  in  the  tene- 
ments, of  course,  may  be  done  by  lay  persons.  You  can  not  get  doctors  enough  to 
do  that.     But  the  direction  of. that  work  is  in  the  hands  of  physicians. 

Mr.  HocH.  If  you  thought,  then,  that  this  bill  meant  nothing  other  than  the  stimu- 
lation, the  encou  agement  of  communities  and  of  States  to  do  work  in  the  same  manner 
as  it  is  done  in  New  York  City,  you  would  not  have  any  objection  to  it,  would  you? 

Dr.  KosMAK.  No,  sir;  but  I  do  not  see  how  it  can  be  done  through  the  medium  of 
this  bill.     I  am  very  frank  in  making  that  statement. 

Mr.  Webster.  Doctor,  a  moment  ago  you  referred  to  some  organization  or  society 
in  New  York  dealing  with  the  questions  of  child  welfare  and  maternity  care,  and  you 
said  they  had  raised  some  money  for  the  purpose  of  gathering  statistics  along  those 
lines.     Is  that  organization  made  up  of  both  laymen  and  medical  men? 

Dr.  KosMAK.  It  is  largely  made  iip  of  lay  persons. 

Mr.  Webster.  About  what  percentage  of  the  membership  is  made  up  of  medical 
men? 

Dr.  KosMAK.  Well,  Mr.  Webster,  I  am  not  prepared  to  answer  that.  It  is  an 
organization  Avith  a  great  many  hundred  members.  I  can  not  say  how  many.  There 
are  very  few  medical  men  in  it.  and  the  medical  men  who  are  members  of  the  associa- 
tion are  merely  contributors  to  its  funds.  With  the  exception  of  the  medical  board, 
which  consists  of  fi^-e  men,  there  are  no  other  medical  men  directly  interested  in  the 
work  of  the  association. 

Mr.  Webster.  Has  this  bill  been  presented  to  that  association? 

Dr.  KosMAK.  Yes. 

Mr.  Webster.  And  considered  by  it? 

Dr.  KosMAK.  Yes. 

Mr.  Webster.  And  indorsed  by  it? 

Dr.  KosMAK.  Yes. 

"Sir.  Webster.  Bv  what  percentage  of  votes  was  this  bill  indorsed  bv  that  associa- 
tion? '  '  .  ' 

Dr.  KosMAK.  There  w&s  no  vote  taken,  as  I  remember  it. 

Mr.  Webster.  Were  you  present  at  the  time  it  was  considered? 

Dr.  KosMAK.  I  was  present  at  some  of  the  meetings.  I  do  not  recollect  having 
been  present  when  any  vote  was  taken,  no. 

Mr.  Webster.  Was  there  any  substantial  division  of  sentiment  in  the  organization 
with  respect  to' this  bill? 

Dr.  KosMAK.  No. 

Mr.  Webster.  It  was  pretty  nearly  unanimous  in  favor  of  the  bill,  was  it  not? 

Dr.  KosMAK.  Yes,  sir. 

Mr.  Webster.  Now  a  moment  ago  you  read  to  us  a  resolution  adopted  by  some 
gynecological  society,  and  you  stressed  the  fact  that  that  organization  was  made  up 
entirely  of  medical  men. 

Dr.  KosMAK.  Yes,  sir. 

Mr.  Webster.  In  reading  the  resolution  I  failed  to  see  any  peculiar  medical  aspect 
of  it.  It  seems  to  me  that  it  is  dealing  with  questions  of  policy,  political  questions 
in  a  broad  sense,  which  could  be  passed  upon  just  as  intelligently  by  any  organization' 
of  men,  not  doctors,  as  by  men  of  that  profession.  WTiat  aspect  of  that  resolution  has 
any  peculiar  medical  bearing? 

Dr.  KosMAK.  Well,  the  first  section: 

■'The  committeeis  in  thorough  accord  Math  the  ends  which  this  bill  seeks  to  attain, 
namely,  the  protection  of  the  health  of  mothers  and  infants.  " 


PUBLIC   PROTECTION    OF    MATERNITY   AND    INFANCY.  105 

Mr.  Webster.  That  is  a  thin^;  upon  whidi  any  intcllijicnt  mechanic,  farmer,  or 
l)usineas  man  could  express  an  ojiinion? 

Dr.  KosMAK.  Well,  Mr.  Webster,  without  ^oiiiK  any  further,  permit  mo  to  state 
that  it  is  impossible  to  divorce  entirely  a  medical  question  from  a  lay  fjuestion,  bfi- 
cause  the  laity  are  the  people  concerned. 

Mr.  Webster.  Yes. 

Dr.  KosM.\K.  We  can  not  estalilish  ourselves  in  the  position  of  dictators.  We 
must  have  the  coojjeration  and  coordination  of  lay  j)eople,  and  we  have  no  intention 
of  placing  ourselves  on  a  pedestal  without  permitting  the  others  to  be  gathered  around 
us.    We  can  not  do  that. 

Mr.  Webster.  No  individual.  Doctor,  has  more  respect  for  your  profession  than  I 
I  was  merely  suggesting  that  with  respect  to  general  questions  of  policy  and  of  govern- 
ment, no  peculiar  merit  attached  to  the  opinion  of  your  profession.     Now,  the  ques- 
tion of  whether  or  not  it  is  wise  to  provide  for  maternal  care  and  the  care  of  infants 
is  not  peculiar  to  any  profession,  is  it?     The  wisdom  of  doing  that? 

Dr.  Kosmak.  No,  of  course  not. 

Mr.  Webster.  Now,  then,  read  the  next  section. 

Dr.  Kosmak  (reading): 

"We  indorse  the  coordination  of  all  health  activities  under  one  head." 

Mr.  Webster.  That  is  a  question  of  general  policy. 

Dr.  Kosmak.  Yes. 

Mr.  Webster.  Upon  which  any  citizen  could  express  an  intelligent  opinion  wholly 
disassociated  from  any  professional  work. 

Dr.  Kosmak.  Naturally.     [Reading:] 

"We  oppose  in  principle  the  control  of  health  measures  by  nonmedical  individuals 
or  boards." 

I  think  that  is  medical,  is  it  not? 

Mr.  Webster.  Is  that  not  a  thing  upon  which  any  intelligent  citizen  might  have 
a  valuable  opinion? 

Dr.  Kosmak.  I  think  ii  the  question  were  asked  of  the  average  intelligent  citizen 
he  would  probably  say,  "Yes,  I  would  rather  have  a  doctor  take  care  of  me  "—I  know 
I  would — "than  a  lay  person." 

Mr.  Webster.  Exactly.     Now,  the  next  section. 

Dr.  Kosmak  (reading): 

"We  believe  in  the  local  control  of  health  activities  as  distinguished  from  Fed- 
eral." 

"We  do  not  indorse  the  Sheppard-Towner  bill  in  its  present  form  because  it  does 
not  conform  to  the  above  principles,  and  because  it  embodies  the  questionable  plan 
of  subsidizing  State  health  activities." 

Mr.  Webster.  Now,  Doctor,  is  your  objection  to  this  bill  predicated,  either  in 
whole  or  in  paTt,  upon  the  idea  that  it  subsidizes  State  activities  along  health  lines? 

Dr.  Kosmak.  In  part.  yes. 

Mr.  Webster.  Well,  if  the  Federal  Government  took  it  over  as  an  undependent 
operation,  as  you  have  suggested,  the  Federal  Government  would  have  to  pay  for  it, 
would  it  not? 

Dr.  Kosmak.  That  would  not  be  considered  a  subsidy,  would  it? 

Mr.  Webster.  What  difference  in  principle  would  there  be  between  the  Federal 
Government  furnishing  the  money  itself  or  the  Federal  Government  furnishing  a 
portion  of  the  money  to  be  supplemented  by  a  like  amount  supplied  by  the  States? 

Dr.  Kosmak.  Well,  as  I  understand  this,  Mr.  Webster,  that  is  not  being  done  now 
in  other  cases.  The  Immigration  Service  is  directed  from  Washington  without  any 
State  interference  or  suggestion  or  coordination  or  cooperation. 

Mr.  AVebster.  It  is  not  apparent  to  me  how  the  wholesome  operation  of  a  bill 
caring  for  mothers  and  children  would  be  affected  by  the  source  from  which  the  money 
comes. 

Dr.  Kosmak.  Well,  I  do  not  know  that  it  would  be,  but  it  is  the  apphcation  of  the 
funds  and  the  method  in  which  they  are  to  be  applied,  and  the  conditions  under  which 
they  are  to  be  applied  that  we  as  medical  men  object  to. 

Mr.  Webster.  Well,  that  departs  altogether,  does  it  not,  from  the  question  of 
subsidy,  and  goes  to  the  question  of  how  the  money  raised  by  subsidy  shall  be 
expended? 

Do  you  not  believe.  Doctor,  that  we  have  reached  the  point  in  this  Nation  where 
it  is  the  duty  of  the  Government  to  take  some  appropriate  action  for  the  care  of  mothers 
and  infant  children? 

Dr.  Kosmak.  I  do. 

Mr.  Webster.  And  the  differences  that  are  existing  between  us  at  this  time  are 
differences  of  detail,  are  they  not? 

Dr.  Kosmak.  Of  method. 


106  PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY. 

Mr.  Webster.  As  to  how  that  end  is  to  be  achieved.  So,  whereas  we  may  differ 
as  to  the  methods  to  be  employed,  we  do  not  differ  as  to  the  great  fundamental 
question  that  the  Government  ought  to  take  some  intelligent  action  for  the  care  of 
mothers  and  infant  children? 

Dr.  KosMAK.  Yes. 

Mr.  Webster.  That  is  all. 

Mr.  Lea.  I  understand  you.  Doctor,  to  concede  that  during  recent  years  there 
has  been  a  great  improvement  in  maternal  care  and  child  welfare  in  New  York,  and 
that  during  that  time  the  child  hygiene  organization  has  done  effective  work?  Are 
there  any  other  reasons  that  you  would  suggest  for  that  improvement  in  New  York? 

Dr.  KosNAK.  I  think  one  reason  is  to  be  found  in  the  better  economic  conditions 
under  which  most  of  our  people  live.  They  are  able  to  provide  themselves  with  a 
greater  number  of  comforts;  they  are  able  to  take  care  of  themselves  in  a  better  way; 
their  housing  facilities  are  improved,  and  in  that  way  I  think  that  some  of  the  reduc- 
tion in  morbidity  must  be  sought. 

Mr.  Lea.  Have  there  been  any  improvements  in  the  sanitary  laws  or  the  pure  food 
and  drug  act  within  recent  years;  that  is,  as  far  as  the  administration  of  it  in  New  Y'ork 
is  concerned? 

Dr.  Kosmak.  I  believe  not.  I  think  they  are  still  going  along  under  the  same 
laws  that  have  been  in  force  for  a  number  of  years. 

Mr.  Lea.  The  work  of  the  children's  hygiene  organization  is  the  only  new  work 
that  the  Government  has  done  in  recent  years  in  New  York? 

Dr.  Kosmak.  What  do  you  mean  by  "child-hygiene  organization"? 

Mr.  Lea.  This  organization  of  which  Dr.  Baker  has  charge.  Is  that  the  only  work 
that  the  Government  has  done  in  recent  years  to  improve  these  conditions? 

Dr.  Kosmak.  Well,  Mr.  Lea,  that  is  not  recent.  That  work  has  been  done  for  some 
time,  and  it  is  done  through  the  department  of  health,  the  municipal  department  of 
health.  There  is  no  other  government  organization  that  I  know  of  that  is  active  in 
this  field . 

Mr.  Lea.  I  understood  that  that  has  been  in  effect  about  eight  years. 

Dr.  Kosmak.  I  believe  so,  yes;  perhaps  longer. 

Mr.  Lea.  It  was  during  that  period  that  the  improvement  has  been  made? 

Dr.  Kosmak.  Yes;  by  strictly  local  organizations,  the  New  York  Department  of 
Health,  aided  and  cooperated  in  by  a  number  of  private  organizations. 

The  Chairman.  Are  there  any  other  questions,  gentlemen? 

Mr.  Hawes.  Doctor,  the  nurse  is  the  assistant  to  the  physician? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  Primarily  trained  by  the  physician? 

Dr.  Kosmak.  Yat-. 

Mr.  Hawes.  And  as  new  knowledge  comes  to  the  medical  profession,  that  is  im- 
parted to  the  trained  nurse  by  the  physician? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  And  one  of  your  objections  to  this^bill  is  that  95  per  cent  of  the  effective 
work  done  in  the  interest  of  protecting  maternity  and  the  child  is  medicinal? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  So  that  you  object  to  the  5  per  cent  controlling  the  95  per  cent  in  the 
matter  of  administration.     Is  that  your  idea? 

Dr.  Kosmak.  I  do. 

Mr.  Hawes.  I  understand,  Doctor,  that  you  favor  full  and  ample  investigation 
and  proper  appropriations  by  the  Federal  Government  in  the  matter  of  investigation, 
statistics,  reports,  and  advice  to  be  sent  to  the  States? 

Dr.  Kosmak.  Yes,  sir. 

Mr.  Hawes.  So  that  your  objection  to  this  bill  can  be  analyzed  aa  about  three  or 
four  objections. 

First,  you  believe  that  it  should  be  directed  by  a  skilled  physician? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  Second,  that  national  control  should  not  dominate  local  control. 

Dr.  Kosmak.  No;  it  should  not. 

Mr.  Hawes.  And  probably  your  third  objection  is  that  this  bill  does  not  define  in 
any  way  what  the  national  function  will  be,  but  leaves  it  to  some  board  to  be  appointed 
in  the  future.  In  other  words,  Congress  does  not  say  how  this  money  shall  be  spent, 
but  some  board  wluch  will  be  created  in  the  future  will  say  how  it  shall  be  spent? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  Not  in  the  volume  of  money  but  in  the  manner  of  expenditure? 

Dr.  Kosmak.  Yes. 

Mr.  Hawes.  That  is  about  your  position,  is  it? 

Dr.  Kosmak.  Yes;  if  I  follow  you. 


PUBLIC   PROTECTION    OK    MATERNITY   AND   INFANCY.  107 

Mr.  Webster.  Mr.  Chairman,  there  is  one  matter  that  has  been  called  to  my 
-attention  in  the  last  moment. 

Doctor,  do  you  understand  that  the  Children's  Bureau  of  the  Labor  Department 
is  a  lay  organization? 

Dr.  KosMAK.  I  do  believe  so.  I  think  it  is  dominated^ — the  head  of  it  is  a  lay 
person. 

Mr.  Webster.  Do  you  know  that  on  its  medical  staff  there  are  13  physicians? 

Dr.  KosMAK.  Yes. 

Mr.  Webster.  I  will  read  their  names:  Grace  L.  Meigs,  Frances  Sage  Bradley, 
Florence  Brown  Sherbon,  Dorothy  Reed  Mendenhall.  Anna  E.  Rude,  M.  Ruth 
McGuire,  Ada  E.  Schweitzer.  Margaret  E.  Stewart,  Edith  S.  Michael,  Theodora 
Wheeler,  Bertha  F.  Johnson,  Florence  L.  McKay,  and  Ella  Oppenheimer.  All  of 
these  persons  are  licensed  practicing  physicians. 

Dr.  KosMAK.  Yes;  I  suppose  so. 

Mr.  IIawes.  Mr.  Webster,  do  you  find  any  men  in  that  list  of  doctors? 

Mr.  Web.ster.  There  seem  to  be  no  men  on  this  list.  It  has  a  medical  staff  of  13 
physicians  and  9  nurses.  You  do  not  make  any  point  of  these  physicians  being 
"women,  do  you.  Doctor? 

Dr.  KosMAK.  No. 

Mr.  Webster.  Whether  they  are  men  or  women  has  nothing  to  do  with  the  fact 
-of  their  being  practicing  physicians? 

Dr.  KosMAK.  Absolutely  not.  May  I  say  in  answer  to  that,  I  might  bring  up  a 
comparative  picture?  The  health  activities,  the  social  welfare  work  done  by  any 
large  commercial  organization,  a  life  insurance  company,  manufacturing  establish- 
ment, or  otherwise,  those  activities  are  directed,  as  far  as  the  application  of  medici- 
nal methods  is  concerned,  by  physicians.  These  phy^sicians  are  employ-ed  and 
under  the  direct  control  of  lay  persons. 

I  might  also  call  your  attention  to  the  fact  that  section  3  of  this  bill  reads  as  follows: 

"That  the  Children's  Bureau  of  the  Department  of  Labor  shall  be  charged  with 
.  the  carrying  out  of  the  provisions  of  this  act,  and  the  Chief  of  the  Children's 
Bureau  "shall  be  the  executive  officer.  The  Chief  of  the  Children's  Bureau,  as 
executive  officer,  is  hereby  authorized  to  form  an  advisory  committee  to  consult 
with  the  Chief  of  the  Children's  Bureau' — she  is  merely  authorized;  she  is  not  com- 
pelled to  do  it.  She  may  do  it  if  she  wants  to,  but  she  doesn't  have  to — "and  to 
ad\dse  concerning  any  problems  which  may  arise  in  connection  with  the  carrying  out 
of  the  provisions  of  this  act,  such  advisory  committee  to  consist  of  the  Secretary  of 
Agriculture,  the  Surgeon  General  of  the  United  States  Public  Health  Service,  and 
the  United  States  Commissioner  of  Education." 

There  is  one  physician  provided  for  there. 

Mr.  Cooper.  I  might  say.  Doctor,  the  Senate  amendment  directs  the  Chief  of  the 
Children's  Bureau  to  form  that  committee  to  consult  with  the  bureau. 

The  Chairman.  The  doctor  is  not  expected  to  know  those  amendments.  The 
Sheppard-Towner  bill  as  it  stands  is  before  us.  I  do  not  think  he  could  be  held 
accountable  for  that  information. 

Dr.  KosMAK.  Then,  out  of  that  board  you  have  three  lay  people  and  one  physician. 
It  is  merely  an  advisory  board.  It  is  not  necessary  to  follow  any  of  their  rules  or 
recommendations. 

Mr.  Webster.  Would  your  objection  in  that  respect  be  met  if  the  law  were  changed 
so  as  to  make  the  formation  of  such  an  advisory  board  mandatory? 

Dr.  Kos.viAK.  Xo;  it  would  not  meet  my  objections,  because  the  carrying  out  of 
the  act  would  still  be  in  the  hands  of  the  Children's  Bureau,  which  is  a  lay  organiza- 
tion, primarily  speaking. 

Mr.  Webster.  Well,  what  point  do  you  attach  to  its  being  discretionary,  when  you 
say  it  would  not  make  any  difference,  so  far  as  you  are  concerned,  if  it  were  mandatory? 

Dr.  KosMAK.  It  is  merely  an  advisory  board.  The  executive  work  is  still  left  in 
the  hands  of  the  head  of  the  Children's  Bureau. 

Mr.  Webster.  So  t'lere  is  not  really  any  point  in  the  proposition  that  the  appoint- 
ment of  the  board  is  directory  merely?  There  is  really  no  point  in  the  proposition 
that  under  the  language  of  the  original  bill  the  appointment  of  such  a  board  is  direc- 
tory merely? 

Dr.  KosMAK.  Xo. 

The  Chairman.  Are  there  any  other  questions  to  ask  the  doctor?  If  not.  Doctor, 
we  will  excuse  you. 

Mr.  Towner.'  I  woul  I  like  to  call  the  Doctor's  attention  to  some  provisions  in  the 
bill. 

Doctor,  in  section  4  of  the  bill  you  will  notice  that  the  legislative  authority  of  the 
act  is  to  designate  or  authorize  the  creation  of  a  State  agency  which  is  to  administer 


108  PUBLIC   PROTECTION   OF   MATERZsTITY  AND   INFANCY. 

this  act,  so  that  it  is  absolutely  within  the  control  of  the  legislature  of  the  State  as 
to  how.  within  the  State,  the  act  shall  be  administered. 

Dr.  KosMAK.  1  regret  to  say  that  I  do  not  agree  with  that.  I  was  asked  that  ques- 
tion in  the  earlier  part  of  the  session,  and  I  called  attention  to  the  fact  that  subsequent 
lines  in  this  paragraph  nullifies  what  has  been  granted  in  previous  lines,  because  the 
Children's  Bureau  may  withhold  the  funds  that  have  been  appropriated,  in  case  the 
rules  and  regulations  formulated  by  the  State  agency  do  not  agree  with  those  for- 
mulated by  the  Children's  Bureau. 

Mr.  Towner.  We  are  not  coming  to  that  now,  Doctor.  I  just  wanted  to  call  your 
attention  to  that  provision  at  this  time.     Now,  in  the  same  section  there  is  this  proviso ; 

''Provided,  That  in  any  State  having  a  child- welfare  or  child-hygiene  division  in  its 
State  agency  of  health  the  said  State  agency  of  health  shall  administer  the  provisions 
of  this  act  through  such  divisions." 

It  would  be  perfectly  within  the  determination  of  a  State  to  say  who  should  or  who 
should  not,  or  what  authority  should  administer  this  act,  would  it  not? 

Dr.  KosMAK.  Yes. 

Mr.  Towner.  So  that  the  State  could  place  within  its  health  department,  whatever 
that  was,  the  administration  of  this  act? 

Dr.  KosMAK.  Yes,  sir. 

Mr.  Towner.  Could  it  not  do  so? 

Dr.  KosMAK.  Provided  the  administrative  features  agreed  with  those  that  had  been 
put  forward  by  the  Children's  Bureau. 

Mr.  Towner.  We  are  not  discussing  that.  I  will  come  to  that  in  a  moment.  The 
only  proposition  I  am  asking  you  about  is  that  each  State  can  determine  for  itself 
whether  or  not  the  administration  of  the  act  shall  be  under  its  health  agency  or  not; 
so  that  if  they  want  to  put  it  under  the  health  agency  they  can  do  so.     Is  that  not  so? 

Dr.  KosMAK.  Yes. 

Mr.  Towner.  Novp  then,  the  only  situation  in  which  you  say  that  this  Children's 
Bureau  can  dominate  is  through  the  administration  of  the  funds  here  in  Washington, 
is  it  not? 

Dr.  KosMAK.  Yes,  sir. 

Mr.  Towner.  Is  it  absolutely  essential  for  a  State  to  abandon  its  policy  if  this  bill 
is  passed? 

Dr.  KosMAK.  No;  but  I  understand — I  gather  from  the  wording  of  the  bill  that  it 
would  have  to  abandon  whatever  policy  it  had  determined  on.  if  that  policy  did  not 
adapt  itself  to  the  regulations  made  by  the  Children's  Bureau.  I  am  sorry,  Imt  I 
can  not  see  any  other  interpretation  for  that  feature . 

Mr.  Towner.  I  think,  Doctor,  that  you  are  correct,  based  upon  the  assumption 
that  that  is  true,  but  the  assumption  that  it  would  control  its  entire  policy  is  based 
upon  the  fact  that  in  some  way  or  other  the  State  would  be  compelled  to  accept  it. 
Is  the  State  compelled  to  accept  it? 

The  Chairman.  Judge  Towner,  I  regret  to  be  obliged  to  break  in,  but  it  seems  to 
me  that  you  are  appearing  more  as  counsel  than  you  are  in  directing  the  forces  of 
the  proponents,  and  you  are  to  have  your  time  in  rebuttal;  meanwhile  time  is  taken 
away  from  the  committee  witness  and  the  committee  with  respect  to  the  testimony 
now  before  it. 

Mr.  Towner.  There  is  no  question,  Mr.  Chairman,  but  that  you  are  exactly  right. 
I  am  certainly  prejudiced  in  favor  of  this  bill. 

The  Chairman.  We  do  not  object  to  that  in  the  least,  but  we  want  to  give  the  other 
side  a  chance,  and  I  will  have  to  ask  you  to  defer  that  until  your  time  comes. 

Mr.  Towner.  If  it  is  at  all  unpleasant  to  the  chairman,  I  shall  not  further  press  it. 

The  Cn.^iRMAN.  It  is  very  agreeable  to  the  chairman,  but  the  members  of  the  com- 
mittee have  complained  and  I  think  it  is  out  of  order. 

Are  there  other  questions  that  the  members  of  the  committee  would  like  to  ask  the 
witness?     The  Chair  hears  none,  and  we  thank  you.  Doctor. 

We  have  about  10  minutes  remaining  this  morning,  gentlemen.  Shall  we  go  on  or 
stop  now? 

Mr.  HuDDLESTON.  If  anybody  present  can  express  himself  in  the  time  limit,  I 
would  like  to  hear  him. 

The  Chairman.  There  is  one  witness  here  who  has  asked  for  10  minutes,  and  per- 
haps that  will  be  enough  for  what  he  wants  to  say.  I  will  call  him  now.  He  is  Mr. 
Anderson. 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  109 

STATEMENT  OF  MR.  H.  B.  ANDERSON,  REPRESENTING  THE  CITI- 
ZENS' MEDICAL  REFERENCE  BUREAU,  145  WEST  FORTY-FIFTH 
STREET,  NEW  YORK  CITY. 

Mr.  Anderson.  Mr.  ('hairniaii  and  gentlemen  of  the  committee,  I  represent  the 
Citizens'  Medical  Reference  Bureau  (in  oppositon  to  compulsory  medicine),  145  West 
Forty-fifth  Street,  New  York  (Jity. 

By  way  of  explanation  will  saj'  that  this  bureau  is  not  a  medical  organization.  It  is 
an  organization  of  citizens.  The  idea  in  calling  it  the  Citizens'  Medical  Reference 
Bureau  is  that  wo  l)elieved  that  if  facts  of  a  chiefly  medical  nature  which  are  ignored 
by  advocates  of  compul-ory  medicine  were  taken  into  consideration  there  would  be  no 
basis  for  compulsory  medicine. 

I  A\-ish  at  this  time  simply  to  briefly  call  attention  to  reasons  why  we  believe  the  bill 
to  be  paternalistic  and  therefore  not  to  the  best  interests  of  the  public. 

Proponents  of  this  l)ill  have  frankly  stated  that  they  did  not  suppose  the  Government 
would  wish  to  appropriate  money  to  the  States  without  exercising  some  control  over 
the  money. 

As  a  matter  of  fact,  the  bill  actually  provides  in  section  8  that  States  desiring  to  avail 
themselves  of  the  benefits  of  the  act  shall  submit  to  the  Children's  Bureau  for  its 
approval  ''detailed  plans  for  carrying  out  the  provisions  of  this  act."  In  other  words, 
the  plans  of  the  States  would  be  subordinated  to  conform  to  those  approved  by  the 
Children's  Bureau.  Section  4  further  provides  that  the  Children's  Bureau  may  recom- 
mend to  the  State  agencies  cooperating  under  the  act  the  appointment  of  advisory 
committees,  both  State  and  local,  and  how  those  committees  shall  be  constituted. 

Proponents  of  this  bill  frankly  state  that  some  of  the  western  States  are  lax  on  this 
matter  of  maternity  and  infant  hygiene,  and  refer  to  this  laxity  as  a  ''stain."  Many 
States,  however,  may  not  regard  it  as  a  "stain"  not  to  carry  on  work  of  this  kind,  and 
we  take  the  position  that  it  is  not  the  province  of  the  Federal  Government  to  try  to 
whip  these  States  into  line  either  by  appropriating  money,  which  has  been  referred  to 
as  a  "species  of  T)ribery,"  or  indirectly  ])y  so-called  educational  methods. 

If  a  private  organization  takes  it  upon  itself  to  try  and  have  maternity  and  infant 
hygiene  legislation  parsed  by  the  various  States,  that,  of  course,  is  an  entirely  different 
matter  from  the  Federal  Government  doing  so.  Neither  is  it  the  function  of  the 
Federal  bureau  to  seek  to  influence  State  legi -elation  of  other  kinds  relating  to  health 
matters. 

Under  the  theory  that  the  child  has  a  right  to  he  ''w^ell  born,"  and  goaded  on  by  a 
mass  movement  in  which  various  private  organizations  were  working  together  with  the 
Children's  Bureau,  there  is  no  end  to  the  dra'^tic  medical  interference  that  might  be 
sought  of  expectant  mothers  and  infant*^.  This,  I  lielieve,  constitutes  the  most 
serious  danger  in  connection  with  this  bill.  \Miether  this  interference  be  as  a  result  of 
State  legislation  secured  a^  a  result  of  campaigns  conducted  by  the  Children's  Bureau 
or  without  any  particular  State  legislation,  the  possible  abuses  are  appalling. 

If  thi<  bill  were  allowed  to  pa-s  it  would  serve  a-'  an  entering  wedge  for  other  legisla- 
tion that  would  enormously  increase  the  tax  burdens. 

A  study  of  Children's  Bureau  publication  No.  62,  conference  series  No.  2,  giving 
the  minimum  standards  for  child  welfare  adopted  by  the  Washington- and  regional 
conference  on  child  welfare,  1919,  will  show  that  it  would  require  hundreds  of  millions 
of  dollars  annually  to  can'y  out  those  standards. 

It  is  disappointing,  to  say  the  least,  that  proponents  o.  this  oill  have  given  such  a 
misleading  impression  of  what  might  be  expected  were  this  bill  allowed  to  become  a 
law. 

Statistics  from  the  United  States  Census  Bureau  plainly  show  a  lower  maternity 
and  in-fant  mortality  in  the  rural  districts  of  the  birth  registration  area  where  such 
work  as  this  bill  provides  is  said  to  be  the  most  needed  than  in  the  urban  districts 
which  are  now  conducting  wrok  of  this  kind. 

Mortality  statistics,  1919,  page  47,  show  a  death  rate  per  1,000  live  oirths  in  1939 
of  7.9  in  cities  in  the  registration  area  against  6.9  in  the  rural  part  of  the  registration 
area  for  all  puerperal  causes  and  2.9  in  cities  in  the  registration  area  against  2  in  the 
rural  part  of  the  registration  ai-ea  for  puerperal  septicemia. 

Birth  statistics  1919.  page  IS,  >?liow  an  infant  death  rate  per  1,000  births  of  89  in  cities 
in  the  registration  area,  against  only  84  in  the  rural  part  of  the  registration  area. 

New  York  City  has  been  referred  to  a  great  deal  as  ha\ing  reduced  the  death  rate 
from  144  to  85.  As  a  matter  of  fact  New  Y^ork  stands  fiftieth  in  the  year  1919  among 
cities  of  the  United  States,  so  far  as  infant  mortality  is  concerned,  and  a  great  many 
of  the  States  will,  I  believe,  make  a  better  showing  than  New  York  City. 

In  closing  I  would  just  like  to  read  a  few  lines  from  a  communication  by  John  P. 
Davin,  M.  D.,  executive  secretary  New  York  Medical  Association,  relating  to  the  bill 
now  under  consideration,  which  appeared  in  the  New  York  Globe  July  7,  1921: 


110  PUBLIC   PROTECTION    OF   MATERNITY  AND   INFANCY. 

"*  *  *  aleader  in  a  recent  Globe  states  that  the  Children's  Bureau  has  reckoned- 
that  15,000  women  die  needlessly  every  year  from  causes  connected  with  childbirth. 
One  death  of  this  kind  in  the  practice  of  a  conscientious  physician  would  be  considered 
a  harrowing  event.  I  venture  to  say  that  the  vast  proportion  of  deaths  of  this  char- 
acter *  *  *  are  due  to  causes  which  no  human  power  could  prevent.  Their- 
occurrence  among  the  wealthy  are  just  as  frequent,  despite  the  highest  medical  skill, 
as  they  are  among  those  who  are  now  exciting  the  interest  of  the  Children's  Bureau. 

"  It  has  been  decided  that  the  American  home  and  American  political  institutions- 
can  not  safely  coexist  in  this  country  along  with  the  sale  of  liquor  to  places  licensed 
by  the  Government.  Will  these  institutions  be  not  endangered  as  well  if  for  the 
supervision  of  the  saloon  there  is  substituted  the  supervision  and  control  of  the  lying- 
in  chamber  by  politically  appointed  officials  of  the  State?" 

I  thank  you. 

The  Chairman.  Without  objection,  the  time  being  up,  we  will  adjourn  until, 
9.30  o'clock  to-morrow  morning. 

(Whereupon,  at  11  o'clock  a.  m.,  the  committee  adjourned  until  9.30  o'clock 
a.  m.,  Wednesday,  July  20,  1921.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Wednesday,  July  20,  1921. 
The  committee  met  at  9.30  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman) 
presiding. 

The  Chairman.  Gentlemen  of  the  committee,  if  you  will  give  attention  we  will 
proceed  to  the  further  consideration  of  H.  R.  2366.  The  chair  will  ask  Dr.  Mongan 
to  appear  as  the  first  witness. 

STATEMENT  OF    DR.  CHARLES    E.  MONGAN,  SOMERVILLE,  MASS., 
REPRESENTING  THE  SOMERVILLE  MEDICAL  SOCIETY. 

Dr.  Mongan.  Mr.  Chairman  and  gentlemen  of  the  committee,  I  am  not  going  to 
keep  you  very  long.     I  have  promised  your  chairman  that  I  would  be  about  15  minutes. 

The  first  question  that  comes  to  my  mind  is:  What  is  our  work?  What  are  we  trying 
to  find  out  and  on  what  basis  do  we  place  our  figures,  statistics,  and  everything  that 
concerns  this  question  of  what  is  called  "maternity  benefits"?  What  is  maternity 
benefit  and  what  is  a  maternity  death?  Perhaps  I  had  better  go  over  that  first.  The 
term  "maternity  death"  does  not  occur  anywhere  in  scientific  medical  literature. 
There  is  not  any  such  thing  described  as  maternity  death.  The  United  States  Census 
Bureau,  acting  under  the  international  classification  of  diseases,  describes  that  as  the 
puerperal  stage — deaths  in  the  puerperal  stage.  What  are  deaths  in  the  puerperal  stage? 
Any  death  that  happened  from  the  beginning  of  conception — that  is,  during  preg- 
nancy, during  parturition,  during  lactation;  that  is,  when  the  mother  nurses  her  child, 
or  for  one  month  after  the  cessation  of  any  of  those  three  functions,  that  can  be  in  any 
way  connected  with  these  functions,  is  a  death  in  the  puerperal  stage,  and  that  is  the 
method  used  in  collecting  these  statistics.  So  that  when  you  say  you  have  so  many 
deaths,  maternity  deaths,  one  does  not  know  whether  you  mean — if  you  use  the  ex- 
pression "maternity" — whether  you  mean  the  death  after  the  confinement  or  a  death 
after  an  operation  of  Csesarean  section,  which  is  a  maternity  death,  or  a  death  after 
blood  poisoning  in  an  abortion.  And  we  have  many  of  those  cases  where  they  are 
self-induced.  Tliose  go  down  as  maternity  deaths.  A  death  after  an  operation  for 
'extrauterine  pregnancy  is  a  maternity  death.  Scientifically  those  are  deaths  in  the 
puerperal  stage. 

Tnese  statistics  are  collected  on  what  is  called  the  "international  classification  (f 
diseases,"  and  in  this  international  classification  of  diseases,  which  has  been  accepted 
by  most  civilized  countries,  it  expressly  states  that  they  are  not  selected  for  scientific 
purposes;  that  they  are  selected  simply  for  statistical  purposes  and  not  scientific  pur- 
poses. So  that  when  you  draw  your  conclusions  and  you  build  up  anything  on  the 
basis  of  the  international  classification  of  diseases,  remember  that  you  are  talking 
statistically  and  not  scientifically,  and  there  is  a  great  deal  of  difference.  So  much 
for  a  little  illumination;  perhaps  you  have  had  it  all  before,  but  so  much  for  our 
starting. 

In  1916  and  1917  there  came  into  view  an  organization  called  the  American  Associa- 
tion for  Labor  Legislation,  and  this  association  began  a  campaign  for  compulsory  health 
insurance  in  about  13  different  States  simultaneously  in  the  United  States,  and  they 


PUBLK.'   PROTECTION    OF    MATERNITY   AND   INFANCY.  HI 

issued  a  pamphlet,  a  review,  on  compulsory  health  insurance,  in  1910  and  1917.  In 
that  review  was  stated  what  they  were — their  odicers  and  what  international  classi- 
fications they  had  and  international  alliances.  This  [)aTnphlet  bears  ui)on  the  cover 
the  words  "the  American  Association  for  Labor  Legislation,  IS!  East  Twenty-third 
Street,  New  York  City."  and  down  below  "International  Association  for  Labor 
Legislation,  with  its  hoad(iuarters  in  Basel,  Switzerland,  serves  a  bond  of  union  to  all 
who  believe  in  the  necessity  of  labor  legislation."  I  will  leave  that  book  with  you,  if 
you  wish.  It  gives  the  sections  in  the  different  countries.  In  that  organization  and 
in  that  scheme  for  compulsory  health  insurance,  which  was  advocated  by  an  Americ-an 
association  with  international  alliances,  there  is  a  provision  for  maternity  benefits. 
I  will  say  that  since  the  war  the  alliances,  the  foreign  alliances,  are  not  given  in 
the  book.  Whether  it  was  thought  best  to  sever  its  alliances  with  international  organ- 
izations that  had  their  headquarters  in  Basel,  Switzerland,  I  do  not  know,  but  they 
are  the  first  organization  that  ever  introduced  into  the  United  States  the  subject  of 
maternity  benefits.  Now  we  have  reason  to  believe,  those  of  us  who  have  watched 
the  career  of  this  organization,  that  having  been  defeated  in  all  the  State  legislatures 
where  they  introd\iced  their  proposition  for  compulsory  health  insurance,  we  have 
reason'to  believe  that  they  have  taken  up  maternity  benefits. 

Mr.  Newton,  ^^^lat  do  you  mean  by  "maternity  benefits"  in  reference  to  this 
organization?     ^^'■ould  you  call  this  a  "rnaternity  benefit?" 

I)r.  MoNCiAN.  I  take  that  name  because  it  explains  things  better  than  some  other 
expression.  It  is  called  here  a  "maternity  bill."  It  may  change  to-morrow,  I  don't 
know  about  that.     Thev  change  every  other  day. 

Mr.  Newton,  ^^^lat  I  was  trying  to  get  at  was  your  use  of  the  general  term  "mater- 
nity benefits,"  whether  this  came  under  that  general  term. 

Dr.  MoNGAN.  Yes;  it  does  come  into  my  mind  under  that  general  term. 

My  colleague  yesterday  did  not  know  who  was  behind  legislation  of  this  sort,  and 
1  ask  you  to  pay  attention  particularly  to  the  undercurrents  and  the  influences  that 
come  to  the  American  people  under  the  guise  of  labor  legislation  which  has  had  in 
the  past  alliances  \\'ith  international  organizations,  and  I  say  it  comes  pretty  near 
being  internationalism,  and  you  men  who  study  social  questions  can  tell  us  what  it 
means,  its  far-reaching  effect.  It  is  a  thing  that  you  want  to  consider.  Am  I  far 
afield  in  asking  them  why  the  Children's  Bureau  calls  upon  you  to  consider  maternity 
benefits  in  certain  foreign  countries  and  issues  a  pamphlet  telling  you  the  condition 
of  maternity  benefits  in  foreign  countries?  It  goes  further,  and  it  tells  you  on  the 
last  page:  "The  most  comprehensive  study  on  maternity  benefits  and  insurance 
which  has  yet  appeared  in  any  language  is  a  volume  by  Madame  A.  KoUontai." 

Mr.  Newton,  ^yill  you  give  the  reference  there  of  the  Children's  Bureau  publica- 
tion, with  the  designation  of  the  pamphlet  and  page  number? 

Dr.  MoNGA'N.-  This  pamphlet  is  entitled:  "Maternity  Benefit  Systems  in  certain 
Foreign  Countries.  Legal  theories  No.  3.  Bureau  publication  No!  57."  This  is  on 
page  175.  You  are  going  to  Russia  for  maternity  benefits.  The  United  States  is 
?oing  to  Russia  to  ask  Mrs.  KoUontai,  and  you  should  read  what  Sir  Paul  Dukes  says 
af  her  and  her  disruption  of  the  family  in  Russia,  she  who  believes  that  the  family 
Bhould  be  separated.  Sir  Paul  Dukes  is  the  intelligence  officer  of  the  British  Govern- 
ment in  Russia,  and  he  refers  to  Mrs.  KoUontai  in  the  New  York  Times  of  last  Sunday. 
We  are  asked  to  go  to  Russia  and  we  have  been  asked  to  go  to  Russia  in  all  these  things. 
\nd  let  me  tell  you  the  first  germ  of  all  this  thing  came  into  Russia  in  1805,  when  the 
;'zar  ordered  a  hospital  to  be  established  in  connection  with  the  mining  and  metal- 
urgical  industries. 

Mr.  Sanders.  What  was  that.  Doctor? 

Dr.  MoNfiAN.  The  Czar  ordered  the  establishment  of  a  hospital  in  connection  with 
nining  and  metallurgical  industries  in  1806.  That  was  continued  as  a  rule  of  the 
Empire  until  1866,  during  the  cholera  epidemic.  We  had  our  first  maternity  hospital 
inder  government  control  when  the  Czar  ordered  (1866)  that  in  a  factory  which  con- 
listed  of  more  than  1,000  people  there  should  be  a  hospital  and  so  many  beds,  and 
:here  should  be  an  obstetrical  hospital.  He  did  not  want  to  let  these  working  women 
mder  Russian  civilization  get  very  far  from  the  factory  to  have  their  children.  It 
became  so  notoriously  bad  in  Russia,  according  to  that  book,  that  they  did  away  with 
;he  governmental  hospitals  under  that  scheme  and  established  a  compulsory  health 
nsurance  with  maternit\-  benefits,  and  the  countries  that  have  had  compulsory  health 
nsurance  with  maternity  benefits  have  been  Russia,  have  been  Germany,  where  it 
nade  its  greatest  development.  Bismarck  gave  it  as  a  matter  of  policy  and  for  no 
)ther  reason.  It  was  not  in  Gerfnany  thatthese  things  came;  it  was  from  Russia, 
^ubinow  in  Standards  of  Health  Insurance  tells  you  the  whole  story,  or  the  American 
Jedical  Association  Journal  of  June  16,  1916,  will  tell  you  the  whole  story. 


112  PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY. 

Now  we  object  to  taking  any  part  or  parcel  of  any  oriental  civilization  that  gleam- 
through  the  Russian  Empire.  It  is  not  necessary  that  the  American  people  should 
give  over  to  the  Federal  Government  anything  in  the  way  of  administering  the  private 
health  of  the  community.  The  Federal  Government  has  not  given  any  evidence — 
and  I  say  this  with  due  respect — has  not  given  any  evidence,  when  it  gets  out  of 
purely  governmental  affairs,  of  any  appreciable  success,  and  I  have  only  to  quote  to 
you  the  words  Senator  Edge  delivered  yesterday  in  the  United  States  Senate,  when 
he  deplored  the  fact  that  we  were  going  outside  of  our  province  as  a  government  to 
get  into  busines  or  to  set  up  business  or  make  any  more  business  arrangements,  and  you 
are  going  to  do  the  same  thing  that  Senator  Edge  deplores  when  you  are  asked  under 
this  bill  to  take  away  from  those  who  are  peculiarly  trained  and  fitted  to  take  care  of 
the  sick  and  give  it  into  the  hands  of  a  bureau  that  shows  their  competency  by  refer- 
ring you  to  Russia  as  the  best  possible  way  by  which  you  can  administer  health  insur- 
ance and  maternity  benefits. 

Mr.  Cooper.  Where  has  the  Children's  Bureau  ever  referred  you  to  Russia,  relative 
to  this  bill? 

Dr.  Mono  AN.  Where  has  it  referred  me? 

Mr.  Cooper.  Yes. 

Dr.  MoNGAN.  I  do  not  know  that  I  get  you.  This  particular  bill  says  that  the 
Children's  Bureau,  which  is  a  governmental  department  agitating  the  passage  of  this 
bill,  refers  us  to  Russia. 

Mr.  Cooper.  Now  where  do  they  refer  us  to  Russia? 

Dr.  MoNGAN.  Inferentilly  this  thing  is  to  be  given  over  to  the  Children's  Bureau 
for  administration. 

Mr.  Cooper.  Are  you  reading  there  from  the  report  of  the  Children's  Bureau? 

Dr.  MoNGAN.  Yes,  sir. 

Mr.  Cooper.  What  do  they  say  on  that?     I  am  anxious  to  know. 

Dr.  MoNGAN.  They  say:  "The  most  comprehensive  study  of  maternity  benefit»s 
and  insurance  which  has  yet  appeared  in  any  language  is  the  volume  by  Madame  A. 
Kollontai."     I  refuse  personally  to  follow  her,  no  matter  what  she  says. 

Mr.  Sanders.  Have  you  read  the  authority  referred  to  there? 

Dr.  MoNGAN.  It  is  in  Russian.  No,  sir.  Perhaps  I  am  going  too  far  in  taking  the 
word  of  this  governmental  pamphlet.     I  will  withdraw  it  if  you  think  it  is  not  reliable . 

Mr.  Sanders.  No;  what  I  am  asking  is  whether  you  have  read  the  authority  re- 
ferred to  in  there  as  being  the  most  comprehensive  work  on  the  subject. 

Dr.  MoNGAN.  Why,  the  authority,  the  authority — you  mean  have  I  read  Madame 
Kollontai 's  book? 

Mr.  Sanders.  Yes. 

Dr.  Mongan.  No;  I  do  not  read  Russian. 

Mr.  Sanders.  Then  from  all  you  know  that  may  be  an  accurate  statement? 

Dr.  Mongan.  It  may  be  an  accurate  statement.  I  am  not  disputing  the  statement; 
I  am  disputing  the  fact  that  we  in  the  United  States  have  got  to  go  to  Russia  for  infor- 
mation in  regard  to  legislation.     Would  you  like  to  go  there? 

Mr.  Sanders.  Well,  if  it  is  true  that  that  l)ook  referred  to  is  the  most  comprehen- 
sive one  on  the  subject,  do  you  see  anything  wrong  in  the  Children's  Bureau  referring 
to  it? 

Dr.  Mongan.  Yes;  I  do. 

Mr.  Sanders.  Because  the  author  has  written  some  other  things  with  which  you 
do  not  agree? 

Dr.  Mongan.  I  think  that  I  would  disagree  with  about  every  public  document 
that  would  come  from  Madame  Kollontai  on  social  or  medical-social  conditions. 

Mr.  Sanders.  Yes;  but  you  do  not  know  but  what  that  is  an  accurate  statement 
when  they  say  that  is  the  most  comprehensive  thing  on  the  subject. 

Dr.  Mongan.  I  am  not  disputing  that.  I  am  saying  that  is  where  they  tell  us  to 
go  for  information.  The  accuracy  or  inaccuracy  of  the  statement  I  have  nothing  to  say 
about. 

Mr.  Sanders.  What  is  the  objection  to  going  there  for' the  information  if  that  is  a 
comprehensive  work  on  the  subject?  Do  we  not  go  to  foreign  books  for  any  informa- 
tion of  a  scientific  or  helpful  character? 

Dr.  Mongan  .  I  suppose  you  might  go  to  the  Duma,  perhaps,  for  legislation  that  would 
come  before  Congress.  I  think  you  would  take  it,  however,  with  a  grain  of  salt,  or 
your  constituents  would. 

Mr.  Sanders.  That  is  all  right  whether  we  take  it  with  a  grain  of  salt  or  not,  but  I 
see  no  harm,  so  far  as  I  am  concerned 

Dr.  Mongan  (interposing).  All  right,  then:  I  ha^e  no  dispute  with  you  if  you  see 
no  harm  in  it. 


^ 


PUBLIC  PROTECTION   OF   MATERNITY   AND   INFANCY.  113 

Mr.  Sanders.  I  see  no  harm  in  the  Children's  Bureau  referring  to  a  book  written 
in  Russian  upon  the  subject  of  maternity  and  childbirth.     I  would  see  no  harm  in 
them  referring  to  a  (Jcrman  book  written  on  that  subject,  or  to  a  French  book  written 
on  that  subject,  or  to  any  other  book  written  on  the  subject. 
i     Dr.  MoNGAN.  I  have  no  quarrel  with  your  opinions. 

Mr.  Newto.\.  Doctor,  do  you  claim  that  the  Children's  lUireau  indorsed  any  of 
these  maternity  l)euelit  systems  that  were  set  forth  in  Madame  KoUontai's  book? 

Dr.  MoNOAM.  I  think  that  inference  might  ho  taken. 
;i  Mr.  Newton.  That  is  what  I  am  trying  to  get  at,  whether  you  claim  that  the  bureau 
liindorsed  them  or  whether  all  that  they  did  was  to  furnish  the  people  of  this  country 
with  the  information  that  such  and  such  a  country  had  done  such  and  such  a  thing 
along  the  line  of  maternity-benelit  legislation  whether  they  furnished  information 
only  or  whether  they  furnished  information  plus  an  indorsement  and  recommendation? 

Dr.  MoNOAN.  I  think  it  comes  pretty  near  being  an  indorsement.  That  is  the  way 
[I  would  look  upon  it. 

j  Mr.  Newton.  Now  I  would  like  to  have  you  insert  in  the  record,  if  you  do  not  have 
it  available,  anything  in  the  pamphlet  there  that  contains  an  indorsement  of  any 
ipxrticidar  system  advocated  by  Madame  KoUontai. 

Mr.  Denison.  I  think  on  page  11  you  will  find  something  of  that  kind. 

Dr.  MoNGAN.  I  think  you  will  find  a  letter  of  transmittal  on  page  9.  You  will  find 
something  on  page  11  also. 

Mr.  Newton.  I  am  through  now  for  the  time  being. 

Dr.  iloNGAN.  No,  I  think  you  will  find  in  the  letter  of  transmittal,  ■'  No  such  system 
3nce  undertaken  has  ever  been  abandoned."  After  telling  about  all  these  systems, 
'Instead,  the  tendency  of  changes  in  existing  legislation  has  always  been  toward 
including  larger  and  larger  groups  of  the  population,  toward  increased  benefits,  and 
toward  the  compulsory  as  contrasted  with  the  voluntary  principle  of  insurance." 

Mr.  Sanders.  I  would  call  that  a  pure  statement  of  facts,  not  an  indorsement  of 
inything. 

Dr.  MoNGAN.  I  should  call  that  a  pretty  strong  statement.  I  think  most  Americans 
would,  looking  that  over. 

Mr.  Sanders.  Well,  you  and  I  would  differ  as  to  that. 

Dr.  MoNGAN.  Yes,  sir. 

Mr.  Rayburn.  We  do  not  subscribe  to  the  doctrine  of  ''tainted  information."  Do 
v-ou? 

Dr.  Mongan.  I  do  not;  no. 

Mr.  Rayburn.  Wherever  it  comes  from,  if  it  is  good,  you  are  willing  to  take  it? 

Dr.  MoNGAN.  Yes,  but  I  am  suspicious,  to  say  the  least,  and  my  suspicion  grows 
nto  conviction  after  I  take  in  the  whole  situation.  I  will  ask  you  if  any  fair-minded 
pian  would  not  do  the  same?     Now  we  will  go  to  statistics. 

Mr.  Denison.'  Before  you  go  to  that,  may  I  ask  you  a  question? 

I  have  a  statement  which  purports  to  be  a  quotation  from  that  pamphlet  on  page  11, 
ivhich  reads  as  follows; 

The  list  of  countries  having  some  form  of  cash  benefit  for  mothers  during  maternity 
s  impressive." 

Do  you  interpret  that  as  being  an  expression  at  least  of  formal  approval  and  recom- 
nendation  of  the  action  of  those  countries  that  are  examples  for  this  sort  of  legislation? 

Dr.  MoNGAN.  I  think  it  comes  as  near  as  any  head  of  a  bureau  would  go  in  making 
I  recommendation. 

Mr.  Denison.  I  find  another  reference  on  page  10  of  the  pamphlet,  the  same 
Damphlet  that  you  have  been  referring  to,  as  follows: 

"In  the  hope  that  the  information  might  prove  useful  to  the  people  of  one  of  the 
ew  great  countries  which  as  yet  have  no  system  of  State  or  National  assistance  in 
naternity,  the  United  States." 

I  see  here  there  seem  to  be  a  number  of  statements  in  that  pamphlet  which  have 
)een  referred  to  me  by  somebody,  I  do  not  know  whom,  which  at  least  to  a  limited 
xtent  expresses  approval  of  the  systems  in  vogue  in  these  countries,  and  sets  them 
ip  before  the  people  of  the  United  States  as  an  example  that  should  be  followed.  Is 
hat  not  the  impression  you  get  from  the  reading  of  that  pamphlet? 

Dr.  MoNGAN.  Perfectly. 

Mr.  Newton.  Have  you  the  reference  there?  That  is  what  I  am  interested  in 
n  getting  that. 

Dr.  MoNGAN.  Yes;  1  have  got  it  here. 

Mr.  Newton.  The  references  to  the  pamphlet,  so  that  I  can  turn  to  it. 

Mr.  Denison.  Yes;  this  came  to  me  through  the  mails.  I  do  not  know  who  sent 
t,  but  I  found  it  on  my  desk. 

74654—21 8 


114  PUBLIC   PROTECTION   OF   MATEBNITY  AND  INFANCY. 

Dr.  MoNGAN.  Now  as  to  the  effect  of  maternity  benefits  under  Government  con- 
trol in  different  countries,  they  have  not  been  such  a  great  success.  The  English 
find  fault  with  them.  The  English  who  are  in  favor — that  part  of  the  socialists  or 
statesmen  that  are  in  favor  of  the  so-called  maternity  benefits  think  they  do  not 
go  far  enough.  They  do  not  like  the  few  crumbs.  Keep  that  in  mind,  gentlemen, 
in  considering  this,  how  far  and  where  you  are  going  to  limit  this  thing. 

We  have  been  told  about  New  Zealand.  We  have  been  told  of  the  great  work 
that  has  been  done  in  New  Zealand.  Most  of  the  work  that  has  been  done  in  New 
Zealand,  and  the  best  part  of  the  work  that  has  been  done  in  New  Zealand,  has  been 
done  outside  of  Government  control  or  Government  assistance,  private  assistance, 
the  same  as  is  being  done  here — ^private,  I  might  say,  semipublic — under  the  control 
of  doctors,  doctors'  organizations,  hospitals,  district  nursing  associations,  and  all 
those  things  that  go  to  make  up  in  the  large  sense  for  the  health  of  the  community. 

In  England  in  1912  there  was  a  royal  commission  appointed  to  investigate  all  this 
subject.  It  had  its  first  meeting  in  1912.  It  had  its  second  meeting  in  1918  and 
made  its  report  last  August,  and  the  title  of  the  report  is  "Problems  of  population 
and  parenthood,"  and  if  you  will  bear  with  me — I  have  to  do  this  hurriedly  because 
there  are  other  men  coming,  but  these  things  I  would  like  for  you  to  take  in,  as  being 
something  that  you  want  to  know  when  you  have  heard  so  much  from  other  places. 
In  regard  to  the  high  birth  rate  and  high  death  rate  in  neomortality — that  is,  under 
a  year  in  infants — it  says  this:  This  commission  was  presided  over  by  the  Lord 
Archbishop  of  Birmingham,  and  other  members  were  the  Duchess  of  Marlborough, 
Rider  Haggard,  Lady  Willoughby  De  Broke,  the  head  of  Scottish  Church,  a  repre- 
sentative of  the  Catholic  Church,  and  all  of  the  great  scientists  who  are  interested  in 
parenthood,  maternity,  and  population.  Before  this  commission  appeared  Judge 
Lindsay,  of  Denver,  Judge  Neil,  of  Chicago,  and  many  others.  Its  report  was  com- 
prehensive, and  here  is  one  of  the  conclusions: 

"We  do  not  find,  however,  that  this  assumption  is  warranted." 
That  is,  the  relation  between  birth  rate  and  the  relation  between  deaths  of  the 
infant  under  a  year. 

"There  are  many  instances  which  widely  diverge  from  the  customary  correla- 
tion— instances  on  a  large  scale  and  maintained  over  very  prolonged  periods.  It 
is  not  necessary  to  go  outside  of  the  United  Kingdom  for  one  of  these.  In  the  city 
of  Bradford  infant  mortality  ranges  about  the  figure  135  with  a  birth  rate  extremely 
low,  falling  indeed  in  1918  to  about  13.  The  birth  rates  before  the  war  were  higher 
than  this  but  extremely  low.  In  Connaught  there  are  the  largest  families  in  these 
islands,  the  standardized  birth  rate  ranging  from  45  to  50.  Infant  mortality  is  almost 
incredibly  low,  the  customary  figure  for  County  Roscommon  beipg  in  the  neigh- 
borhood of  35.  The  Neo-Malthusiam  contention  that  the  cause  of  a  high  death 
rate  is  a  high  birth  rate  and  that  the  only 'way  in  which  to  reduce  the  death  rate  is 
to  reduce  the  birth  rate  is  clearly  invalid,  in  view  of  such  an  instance  as  this." 

Take  that  under  consideration  when  you  listen  to  these  statistics  that  are  given 
to  you,  and  things  that  are  given  to  you  from  other  countries. 
Again,  and  I  want  you  to  take  this  into  consideration: 

"Finally  we  must  draw  attention  to  the  failure  of  our  present  methods  to  diminish 
neonatal  mortality  in  any  considerable  degree.  With  this  may  be  correlated  the  no 
less  significant  fact  that,  while  infant  mortality  in  this  country  has  been  reduced  by 
about  a  third  during  the  present  century,  that  reduction  was  obtainedcomparatively 
soon,  and  the  rate  of  progress  has  certainly  not  been  maintained.  That,  of  course, 
could  not  be  expected,  but  the  conclusion  which  we  must  reach  from  the  figures, 
especially  in  view  of  the  parallel  course  of  events  on  the  other  side  of  the  Atlantic, 
is  that  the  attempt  to  deal  with  infant  mortality  as  it  now  remains  will  not  succeed 
merely  by  further  effort  on  the  present  lines.  The  abolition  or  eA^en  the  great  further 
reduction  of  infant  mortality  can  only  be  achieved  by  the  hygiene  of  motherhood, 
and  that  is  not  essentially  a  medical  problem,  as  is  shown  by  the  contrast  between 
Connaught,  where  the  medical  and  economic  conditions  are  deplorable;  and  Brad- 
ford, where  those  conditions  are  probably  the  finest  in  the  world  but  where,  owing  to 
social  causes,  there  is  very  little  breast  feeding.  Since  the  Bradford  mothers,  unlike 
the  Irish  peasant  mothers,  do  not  lead  their  real  lives  in  their  houses,  those  houses 
never  become  homes,  in  which  alone,  whether  their  walls  be  of  clay  or  marble,  the 
human  race  can  be  reared.  Among  the  causes  of  neonatal  morbidity  and  mortality 
are  chiefly  the  racial  poisons" — this  is  from  an  English  book,  and  it  is  talking  about 
English  people — "the  racial  poisons,  especially  syphilis  and  alcohol.  Behind  the 
operation  of  these  causes,  as  artificial  feeding,  lie  social  factors.  Those  social  factors, 
when  themselves  considered,  will  be  found  to  be  moral  rather  than  social  or  economic 
in  the  ordinary  senses  of  those  terms.  They  depend  upon  conduct,  and  not  only,  as 
is  evident,  that  of,  for  instance,  the  husband  who  infects  his  wife  and  thus  their  infant 


PUBLIC   PROTECTION   OF   MATERNITY   AND  INFANCY.  115 

with  syphilis,  but  also  upon  (he  conduct,  the  ways  of  (houfihl  and  of  deed,  of  many 
other  persons  and  of  all  classes.  The  tragedies  of  maternity  and  infancy  to-day, 
their  consequences  as  they  will  he,  have  their  roots  in  (he  failure  and  can  he  ended 
only  by  the  practice  of  what  we  may  call  racial  morals." 

Mr.  TowNKR.  What  page  is  that,  Doctor? 

Dr.  MoNOAN.  That  is  page  XCVII.  And  that  is  not  a  ques(ion  of  mateini(y  1  <ne- 
fits  or  legislation  by  government. 

Mr.  Towner.  That  is  the  paging  of  (he  introduction? 

Dr.  MoNGAN.  That  is  the  paging  of  the  introduction,  which  is  the  (onclusi(ns  of 
the  commission,  and  they  are  not  asking  for  Government  rules  or  regulations  or  laws 
to  control  maternity  or  children. 

The  Chairman.  Doctor,  will  you  kindly  give  the  title  of  thislicok  and  the  rame  of 
the  author  and  the  commission? 

Dr.  MoNC.AN.  The  title  of  the  book  is  "Problems  of  Population  and  Parenthood, 
being  the  second  report  and  the  chief  evidence  taken  by  the  National  ]»irth  Pate 
Commifision,   I91S-1920."     It  is  published  by  Chapman  &  Hall  (Ltd.). 

Mr.  Gkaiiam.  You  can  not  get  that  book  here,  can  you? 

The  Chairman.  Yes;  you  can  get  it. 

Dr.  Mon(;an.  I  think  you  can. 

The  Chairman.  Now,  if  you  will  continue.  Doctor. 

Dr.  MoN(iAN.  Now,  gentlemen,  we  feel  that  a  law  of  this  kind,  which  has  not  the 
support  or  the  sympathy  of  any  medical  journal  in  the  United  States;  that  has  not  the 
support  or  sympathy  of  any  group  of  doctors  in  the  United  States,  should  not  be  passed . 
In  the  event  that  a  law  of  this  kind  were  necessary,  there  is  not  any  doubt  but  that 
you  would  get  the  support  and  the  sympathy  of  some  group  of  physicians  in  this  large 
country.  If  this  law  is  passed  it  is  necessary  that  it  should  at  least  have  the  sym- 
pathy if  not  the  support  of  the  medical  profession .  If  it  has  not  the  sympathy  and  the 
support  of  the  medical  profession,  I  am  afraid  it  is  doomed  to  failure.  The  medical 
profession  has  })een  on  the  alert  to  do  all  that  it  can  for  the  individual  citizen  of  the 
United  States  who  might  be  afflicted  mth  any  disease  or  injury.  The  medical  pro- 
fession in  the  house  of  delegates  last  June  at  Boston  passed  a  resolution  in  which  it 
said  it  did  not — the  gist  of  the  resolution  was  that  it  did  not  disapprove  of  the  proper 
exercise  of  the  police  powers  of  the  Ignited  States  in  the  control  of  disease  which  had 
failed  to  be  controlled  in  any  part  of  the  United  States.  It  also  passed  a  resolution 
looking  forward  to  correlate,  to  help  and  to  cooperate  with  the  President  of  the  United 
States  in  the  matter  of  welfare,  the  physical  welfare  of  the  people  of  the  Uuited  States, 
and  it  appointed  a  committee  of  five  members  to  confer  \vith  the  President  as  to  his 
action  and  his  methods  in  taking  care  of  the  people  of  the  United  States. 

We  think  that  medical  practice  belongs  to  the  medical  profession.  Let  me  tell 
you  an  incident.  During  the  war  the  GoA^ernment  was  compelled  to  call  upon  a 
gentleman  of  the  Pennsylvania  Railroad  to  conduct  all  the  railroad  activities  in 
France,  and  Gen.  Atterbury,  of  the  Pennsvjvania  Railroad,  was  sent  over  there. 
In  a  speech  or  at  a  hearing  that  took  place  in  April,  I  think,  before  one  of  the  labor 
boards  concerning  railroad  legislation,  Gen.  Atterbury  made  the  remark,  and  we  make 
the  same  remark  and  stand  by  what  he  said,  that  if  it  was  not  for  the  initiative,  the 
indi^'idual  effort  of  the  American  citizen,  his  instinct  in  dealing  with  things  as  an 
individual,  and  his  grasping  and  striving  for  ideals,  this  country  would  not  be  in  the 
position  that  it  is  in  regard  to  commerce,  industry,  medicine,  art,  or  the  professions. 
And  we  say  in  regard  to  this  bill  that  the  individual  doctors,  acting  throu,gh  their 
societies  have  practically  abolished  some  diseases  such  as  smallpox;  thev  have  con- 
trolled malaria;  they  have  control  of  diphtheria.  We  are  going  dowm  the  line  and 
we  are  making  diseases  less  formidable,  bringing  them  under  better  control,  and  we 
have  done  it  without  asking  for  the  assistance  of  special  legislation  from  anybody, 
whether  it  was  a  city,  a  State,  or  the  Nation,  and  we  are  simply  following  the  tracks 
of  one  of  the  first  practitioners  of  the  United  States,  as  when  old  Dr.  Fuller  went  from 
Plymouth  to  Salem  in  1636,  treating  the  patients  as  he  met  them  at  their  bedsides 
and  their  homes.  We  simply  ask  you  to  allow  this  thing  to  rest.  There  has  been  no 
reason  that  we  can  see  why  the  Government  should  place  this  bureau  under  the 
Commissioner  of  Labor  and  have  more  labor  added  to  it.  Perhaps  some  people  will 
now  understand  why  the  Cabinet  officer,  now  that  he  has  that  bill,  has  been  called 
the  "Secretary  of  Labor."  Also  the  Surgeon  General  probably  has  not  had,  since  he 
gi'aduated,  very  much  bedside  experience  with  maternity  cases,  so  called,  nor,  with 
due  respect,  has  the  head  of  the  Children's  Bureau  of  the  United  States. 

We  simply  ask  you  to  leave  this  thing  to  be  worked  out  as  it  has  been  worked  out 
•before.  Statistics  do  not  mean  anything.  The  American  Medical  Association  Jour- 
nal has  seen  that.  And  in  closing  I  might  ask  you  that  when  you  are  considering 
statistics,  if  you  will  allow  me  to  tell  you  this  little  story,  I  think  it  will  be  illustrative. 


116  PUBLIC  PEOTECTIOF   OF  MATERNITY  AND  INFANCY. 

The  superintendent  of  schools  made  a  journey  once  to  the  elementary  teacher's 
room,  who  was  new,  and  he  said  to  the  elementary  teacher,  "You  will  notice  the 
children  are  not  observing,  and  before  I  go  away  I  will  show  you  that  they  are  not 
observing. "  Ashe  was  about  to  go  out  of  the  room  he  said  to  the  little  ones,  ' '  Give  me 
a  number.  I  will  write  it  on  the  board."  A  little  fellow  raised  his  hand  and  said, 
"24."  And  the  superintendent  wrote  "42."  Then  he  said,  "Now  somebody  else 
give  me  a  number,"  and  another  number  was  given  by  a  little  girl,  "63."  The 
superintendent  wrote  "36,"  and  he  turned  to  the  teacher  as  much  as  to  say,  "I  have 
proven  my  case."  But  like  many  another  good  sport  he  thought  he  would  take  one 
more  chance,  which  was  fatal  to  him,  and  he  said,  "Now  I  am  going  to  ask  some- 
body to  give  me  another  number,  and  a  tongue-tied  boy  in  the  back  of  the  room 
said,  "77."  Now  twist  it  you  sucker."  [Laughter.]  Please  do  not  let  the  statis- 
ticians twist  you  on  statistics.     I  thank  you. 

The  Chairman.  Does  any  member  of  the  committee  desire  to  question  the  doctor? 

Mr.  Newton.  Doctor,  in  the  forepart  of  your  talk  you  defined  what  are  known  as 
"maternity  deaths."  Now,  as  I  gather  from  your  talk  you  are  opposed  to  the  Govern- 
ment, whether  State,  Federal,  or  municipal,  conducting  work  that,  in  a  general  way, 
could  be  called  "maternity  benefit"  work? 

Dr.  MoNGAN.  I  am  opposed  to  the  Government  taking  any  part  by  legislation  in  the 
practice  of  medicine. 

Mr.  Newton.  Well,  in  New  York  City,  according  to  the  testimony  of  Dr.  Baker, 
there  is  work  being  done  along  the  line  of  maternity  benefit,  described  by  her.  My 
impression  from  hearing  her  testimony  was  that  it  was  very  commendable  work  and 
one  that  should  be  continued ;  that  it  had  aided  materially  in  the  course  of  about  10 
years  in  reducing  the  mortality  rate  among  babies  per  thousand  births  from  145  to  85, 
and  had  also  reduced  the  mortality  rate  among  expectant  mothers.  Now  do  I 
understand  it  that  you  are  opposed  to  the  municipality  conducting  work  of  this  kind? 

Dr.  MoNGAN.  I  do  not  understand  that  the  municipality  does  conduct  it. 

Mr.  Newton.  The  city  of  New  York  certainly  is  conducting  work  of  that  kind. 

Dr.  MoNGAN.  I  do  not  understand  it  so,  sir. 

Mr.  Newton.  That  is  the  testimony  of  Dr.  Baker,  who  is  in  charge  of  that  work. 

Dr.  Mongan.  1  understand  that  that  is  a  maternity  center. 

Mr.  Newton.  That  is  what  1  have  been  trying  to  get  out  of  you.  as  to  what  you  mean 
by  "maternity  benefits."  Now,  you  did  not  define  it,  excepting  to  say  that  legisla- 
tion of  this  particular  kind  proposed  here  is  maternity  benefit  legislation.  I  call  the 
work  that  is  carried  on  under  Dr.  Baker  maternity  benefit  legislation,  because  it 
benefits  expectant  mothers,  and  it  benefits  the  child,  and  it  is  my  idea  that  if  legisla- 
tion of  this  kind  is  enacted  it  would  encourage  similar  work  in  the  States,  similar  work 
to  that  which  is  being  carried  on  by  Dr.  Baker  in  New  York  City.  To  that  extent  1 
call  it  maternity  benefit  legislation. 

Now  let  me  get  down  to  this:  Do  you  commend  or  do  you  oppose  the  municipa'ities 
doing  work  such  as  is  now  being  done  in  New  York  City? 

Dr.  Mongan.  1  do  not  know  that  the  municipality  is  doing  the  work,  sir.  You  and 
I  disagree  on  the  premises. 

Mr.  Newton.  Assuming,  then,  that  the  city  of  New  York  is  conducting  maternity 
centers,  if  you  please  to  call  it  that,  do  you  opjjose  the  city's  engaging  in  that  work? 

Dr.  Mongan.  Now  you  have  made  an  assumption,  and  you  have  made  a  layman's 
assumption  of  a  medical  question,  and  I  can  not  answer  it. 

Mr.  Newton.  I  regret  tliat  it  is  impossible  for  a  i^hysician  appearing  here  to  con- 
verse with  a  layman.     I  had  hoped  that  that  was  possible. 

The  Chairman.  1  think,  Mr.  Newton,  that  is  not  quite  right. 

Dr.  Mongan.  What  was  your  qyestion? 

Mr.  Newton.  I  say,  I  had  hoped  that  a  physician  appearing  here  would  be  able  to 
converse  with  a  layman. 

Dr.  Mongan.  So  did  I.- 
Mr. Newton.  But  I  am  afraid  it  is  imijossible. 

Dr.  Mongan.  You  are  afraid  it  is? 

Mr.  Newton.  I  am  afraid  so. 

Dr.  Mongan.  All  right. 

Mr.  Newton.  Then, -you  are  not  familiar  with  the  work  in  New  York  City?  Are 
you  familiar  with  Dr.  Baker's  work  in  New  York  City? 

Dr.  Mongan.  I  am  familiar  in  a  way;  yes.     Would  you  like  to  ask  me  about  it? 

Mr.  Newton.  Do  you  believe  that  that  work  should  be  carried  on  by  the  munici- 
paUty  of  New  York? 

Dr.  Mongan.  No;  I  believe  it  should  be  carried  on  by  doctors,  as  I  understand Jk 
they  are  now  doing  in  that  center  in  New  York. 

Mr.  Newton.  As  I  understand  it,  you  are  opposed  then  to  any  municipality  con 
ducting  work  along  that  general  line?  »ir 


PUBLIC  PROTECTION   OF   MATERNITY   AND   INFANCY.  117 

Dr.  MoNGAN.  I  am  opposed  t<»  any  municipality  conducting  medical  work. 

Mr.  Newton.  Now  I  think  we  understand  ea(;h  other  on  that  particular  point. 

Dr.  MoNOAN.  All  right,  sir. 

Mr.  Newton.  You  referred,  I  believe,  U>  the  book  by  Madame  Kollontai? 

Dr.  MoNGAN.  I  referred  to  a  quotation  from  a  book  by  Madame  Kollontai  in  that 
pamphlet. 

Mr.  Newton.  A  ({notation  from  her — ^)ne  of  the  members  of  the  committee  does 
not  think  that  you  arc  trying  to  answer  my  questions. 

Dr.  MoNGAN.  I  think  I  am  trying  to  answer  your  questions,  but  that  is  the  trouble 
between  a  layman  and  a  physician. 

Mr.  Newton.  I  am  sorry  you  have  such  a  lack  of  respect  for  the  opinion  of  the 
layman. 

Dr.  MoNfiAN.  I  have  the  greatest  respect  for  you  gentlemen.  I  am  simply  telling 
you  how  impossible  it  is  for  a  layman  and  a  physician  to  agree  upon  certain  questions. 

The  Chairman.  Doctor,  let  us  lay  that  aside  and  keep  close  to  the  subject.  We 
are  not  here  to  discuss  differences  between  laymen  and  physicians. 

Mr.  Newton.  Now,  Madame  Kollontai  published  this  book  at  what  time? 

Dr.  Mongan.  It  is  from  State  Insurance  of  Motherhood,  Petrograd,  1916. 

Mr.  Newton.  191(i.  So  that  was  under  the  regime  of  the  Czar.  That  was  before 
there  was  any  such  thing  as  soviet  Russia,  was  it  not? 

Dr.  Mongan.  Yes,  sir. 

Mr.  Newton.  Now  do  you  take  the  position,  Doct(jr,  that  anything  that  at  any 
time  ever  emanated  from  Russia,  whether  before  the  Lenin  regime  or  thereafter, 
should  be  absolutely  barred  from  consideration  by  the  American  i)eop]e;  that  we  are 
not  to  read  anything  that  any  Russian  ever  had  to  say  about  maternity  or  any  other 
subject? 

Dr.  Mongan.  I  did  not  say  any  time  that  they  should  not  read  anything  that  they 
pleased. 

Mr.  Newton.  Then  I  am  unable  to  understand  why  you  object  to  the  Children's 
Bureau  referring  to  a  book  published  in  Russia  in  1916. 

Dr.  Mongan.  Because  it  comes  with  such  weight  of  opinion,  and  because  the  fore- 
word in  this  book  would  lead  one  to  believe  that  that  should  be  followed  as  a  guide  in 
maternity  benefits. 

Mr.  Newton.  So  your  objection  is  to  the  fact  that  the  Children's  Bureau  saw  fit  to 
in  some  way  or  other  indorse  the  views  of  the  book. 

Dr.  Mongan.  Yes,  sir. 

Mr.  Newtqn.  It  is  not  to  the  merely  calling  of  attention  to  the  fact  that  a  certain 
person  has  written  a  book  on  that  subject  and  the  giving  of  extracts  from  it? 

Dr.  Mongan,  No;  it  is  the  general  recommendation.  If  you  want  to  go  to  Russia 
for  your  civilization,  all  right. 

Mr.  Newton.  Butif  the  views  of  that  individual  happen  to  coincide  with  the  \T.eW8 
of  individuals  here  in  this  country,  the  mere  fact  that  they  did,  would  that  be  any 
reason  for  discarding  the  views  of  the  persons  in  this  country  advocating  legislation? 

Dr.  Mongan.  State  your  hypothetical  question  again,  please. 

Mr.  Newton.  I  will  state  it  concretely.  There  are  a  number  of  individuals  here 
in  this  country  who  are  advocating  maternity  benefit  legislation  such  as  is  contained 
in  the  Towner  maternity  bill .  Judge  Towner,  for  example,  is  one  of  those  individuals. 
He  appears  before  the  committees  of  Congress  and  advocates  it.  Now,  for  the  very 
reason  that  a  Russian  woman  has  advocated  such  a  similar  idea,  is  that  a  reason  for 
discarding  the  idea  of  Judge  Towner? 

Dr.  Mongan.  Yes;  based  on  her  idea,  because  her  experience  is  based  upon  condi- 
tions which  do  not  to  any  extent — I  think  I  may  say  it  without  fear  of  contradiction — 
[exist  in  the  United  States. 

;  Mr.  Newton.  But  Judge  Towner,  we  will  assume  for  the  purpose  of  illustration,  is 
;basing  his  argument  not  upon  conditions  in  Russia,  but  upon  conditions  as  we  find 
ithem  in  the  United  States.  Now,  then,  just  because  Madame  Kollontai  comes  in  and 
Iconcurs  witn  Judge  Towner,  should  we  discard  Judge  Towner's  idea?  Should  we  dis- 
[Card  his  idea  because  he  is  unfortunate  enough  to  have  a  Russian  advocate  it? 

Dr.  Mongan.  All  of  which  ideas  are  based  upon  conditions  in  Russia. 
j    Mr.  Newton.  That  is  assuming  something  that  has  not  yet  been  established  as  a 
fact  here.     It  certainly  was  not  set  forth  in  my  hypothetical  question. 
j     Dr.  Mongan.  Oh,  no;  I  know  you  had  a  very  carefully  framed  hypothetical  ques- 
■tion.  ' 

Mr.  Newton.  It  was  based  not  upon  Russian  conditions  but  upon  American  condi- 
jtions. 

Dr.  Mongan.  It  was  based  upon  Russian  conditions,  as  I  understand  it. 

Mr.  Newton.  I  know  of  no  figures  that  have  been  introduced  here  before  this  com- 
mittee or  before  any  of  the  other  committees  upon  the  conditions  of  things  in  Russia, 


I 


118  PUBLIC   PROTECTION   Or  MATERNITY  AND  INFANCY. 

and  no  reference  has  been  made  to  Russia  excepting  your  own  reference  in  reference 
to  Madame  Kollantai. 

Dr.  MoNGAN.  Yes;  the  references  that  were  in  this  book.  I  made  no  reference, 
except  in  a  general  way,  to  conditions  in  Russia,  which  are  pretty  familiar. 

Mr.  Newton.  I  know;  but  you  are  the  one  that  brought  Russia  in. 

Dr.  MoNGAN.  I  brought  Russia  in. 

Mr.  Newton.  It  was  not  Judge  Towner  or  one  of  the  other  proponents  of  this  legis 
lation . 

Dr.  MoNGAN.  Yes;  and  I  will  stand  for  what  I  brought  in. 

Mr.  Newton.  So  your  position  is  this,  that  where  some  individual  from  Russia 
indorses  legislation,  notwithstanding  its  benefit,  because  of  the  fact  that  a  Russian 
indorses  it  this  Congress  should  discard  it? 

Dr.  Mongan.  Your  question  is  so  involved  and  takes  in  so  much  I  should  not  be 
asked  to  answer  it  the  way  you  put  it. 

Mr.  Newton.  I  am  sorry  again  that  a  layman  can  not  ask  questions  that  a  physi 
cian  can  understand. 

Dr.  MoNGAN.  I  doubt  if  the  Supreme  Court  would  accept  that  question  either 
asked  of  a  witness. 

The  Chairman.  Mr.  Newton,  will  you  not  divide  your  question  so  the  doctor  will 
have  no  reason  for  not  answering  it? 

Mr.  Newton.  I  will  be  glad  to  state  that  in  the  simplest  form  possible.  We  will 
assume  again  that  legislation  is  advocated  here  in  America  by  an  American  before 
the  American  Congress.     That  is  perfectly  understandable,  is  it  not? 

Dr.  MoNGAN.  Yes,  sir. 

Mr.  Newton.  And  that  it  is  the  opinion  of  the  members  of  this  committee  thai 
that  legislation  is  beneficial  to  the  American  people. 

Dr.  Mongan.  Yes,  sir. 

Mr.  Newton.  Now,  then,  after  that  has  been  brought  forth  there  appear  betort 
this  committee  the  views  of  a  Russian  woman ■ 

Dr.  Mongan.  On  what  conditions?    American  or  Russian? 

Mr.  Newton.  There  appear  the  views  of  a  Russian  woman,  setting  forth  her  view: 
on  maternity  benefits 

Dr.  Mongan.  Where? 

Mr.  Newton.  In  general. 

Dr.  Mongan.  Oh,  no;  you  can  not  generalize  that  way. 

Mr.  Newton.  Wel|,  then,  we  will  take  it  in  Russia.  We  will  assume  that  she  set 
forth  before  this  committee  her  views  on  maternity-benefit  legislation  in  Russia,  an( 
that  in  setting  that  forth  her  position  is  an  espousal  of  this  particular  legislation— 

Dr.  Mongan.  Now  you  are  setting  forth  something  else. 

Mr.  Newton.  You  will  not  go  that  far? 

Dr.  Mongan.  No. 

Mr.  Newton.  All  right;  we  will  assume,  then,  that  she  stops  immediately  am 
merely  states  her  approval  of  maternity-benefit  legislation  in  Russia.  Then  here  yo 
have  the  testimony  of  an  American  before  an  American  committee  in  favor  of  matei 
nity-benefit  legislation,  which  the  committee  thinks  is  desirable.  On  the  other  han^ 
you  have  an  indorsement  of  similar  legislation  in  Russia.  Now,  do  we  understaa 
each  other  that  far? 

Dr.  Mongan.  You  have  indorsement  of  legislation  on  maternity  benefits  in  Russia 

Mr.  Newton.  In  Russia? 

Dr.  Mongan.  Strike  out  the  word  "similar." 

Mr.  Newton.  Yes;  I  will  go  with  you  that  far.  Now,  because  this  woman  has  ha 
her  views  set  forth  before  this  committee  on  Russian  matters,  would  you  advocat 
discarding  the  proposition  that  has  been  set  forth  by  an  American  before  an  America 
committee  and  which  the  committee  assumes  is  going  to  benefit  America? 

Dr.  Mongan.  I  never  said  I  would. 

Mr.  Newton.  What  is  your  answer,  then?    That  you  would  not? 

Dr.  Mongan.  That  is  not  the  discussion.  It  might  be  an  interesting  contributic 
to  the  discussion  to  have  somebody  come  from  Russia  and  tell  us  about  conditions  i 
Russia,  etc.     Whether  I  would  be  guided  by  it  or  not 

Mr.  Newton.  Oh,  well,  you  are  getting  away  from  the  point ■ 

The  Chairman.  Do  not  interrupt  the  witness;  he  is  entitled  to  answer. 

Mr.  Newton.  I  want  him  to  answer. 

The  Chairman.  He  can  not  do  it  if  you  interrupt  him.  I  want  to  give  hina  a  fi; 
mea'^ure  of  opportunitv.  Will  you  finish  vour  answer.  Doctor?  Have  you  finish) 
it? 

Dr.  Mongan.   I  think  so. 


titli 


PUBLIC  PROTECTIOlir   OF   MATERNITY   AND  INFANCY.  119 

Mr.  Nkwton.  I  have  no  further  quostions  to  ask.  I  wanted  an  anHwer.  I  have 
been  very  unsuccessful  in  getting  an  answer. 

Mr.  CoopKK.  Just  one  short  (luestion.  Doctor.  I  do  not  want  to  detain  you.  You 
are  opposed  to  this  information  that  has  come  to  us  from  Russia  on  this  question, 
("an  you  tell  me  how  many  of  the  medical  profession  in  this  country  have  taken  post 
graduate  courses  at  Berlin,  Vienna,  and  other  European  cities? 

Dr.  MoNCi.w.   I  could  not  answer  that  question. 

Mr.  ("ooi'KK.   You  do  not  object  to  that,  do  you? 

Dr.  M()N"r..\x.   I  do  not  object  to  what? 

Mr.  CoopFAi.  To  the  medical  profession  going  over  there  for  information  and  educa- 
tion? 

Dr.  M().\'(i.\N.  \Vhy,  no. 

Mr.  Gr.\h.\m.  Doctor,  I  was  so  unfortunate  as  not  to  hear  the  earlier  part  of  your 
statement.  Perhaps  I  am  traveling  over  some  ground  you  have  already  covered. 
As  I  understand  this  bill,  it  is  for  the  purpose  of  trying  to  conserve  human  life;  that  is, 
it  is  thought  by  the  sponsors  of  this  measure  that  by  disseminating  information  among 
the  prospecti^■e  mothers  in  the  country,  through  agencies  of  government,  State  and 
Federal,  they  can  get  information  out  to  the  mothers  so  that  they  may  know  things 
that  they  do  not  know  and  thereby  be  better  enabled  to  take  care  of  themselves  and 
have  more  prosjjects  of  saving  their  lives  at  the  time  of  confinement  and  of  the  baby 
being  born  alive  and  continuing  to  lire. 

Now,  if  this  information  can  be  disseminated  among  the  women  of  the  country  in 
that  way,  do  you  not  think  it  is  a  good  thing? 

Dr.  MoNGAx.  Yes. 

Mr.  Gh.\h.\m.  You  think  it  is  a  good  thing  if  it  can  be  done? 

Dr.  MoNGAX.  But  I  think  it  can  be  better  done 

Mr.  Graham.  In  my  question,  you  notice,  I  did  not  say  anything  about  the  agency, 
about  how  it  was  to  be  done,  whether  by  a  doctor  or  anybody  else.  I  am  asking,  if 
that  can  be  done,  whether  it  will  be  a  good  thing. 

Dr.  Mono  an.  If  it  is  disseminated  by — yes. 

Mr.  Graham.  I  did  not  say  by  whom.  I  say  if  it  were  disseminated  it  would  Vje  a 
good  thing.? 

Dr.  MoxoAX.  Yes. 

Mr.  Graham.  Well,  I  think  we  agree  on  that,  because  it  has  a  tendency  to  conserve 
human  life. 

Now,  the  same  thing  is  true  with  regard  to  the  scourge  of  tuberculosis,  is  it  not,  and 
syphilis,  if  you  please — things  that  are  very  vital  to  the  health  of  our  people?  And 
if  by  any  means  information  can  be  spread  among  the  people  that  will  stop  those  things 
it  is  a  good  thing,  is  it  not? 

Dr.  ^loxoAX.  Yes. 

Mr.  Graham.  '  Now,  laying  aside  the  rpiestion  whether  it  is  done  by  doctors  or  whether 
it  is  done  by  laymen  or  nurses,  if  it  can  be  properly  done  you  will  agree  it  is  a  good  thing 
to  do,  will  you  not? 

Dr.  MoxGAx\  Yes. 

Mr.  Graham.  Well  then,  after  all,  is  it  not  a  question  for  this  committee  to  determine 
and  for  the  Congress  to  determine,  whether  that  can  be  done  by  the  Government  in 
an  effective  and  proper  way? 

Dr.  MoxGAX.  It  might  be  a  good  thing  for  them  to  determine  whether  it  can  be  or 
not. 

Mr.  Graham.  Yes.  And  if  it  can  be  done  in  an  effective  and  proper  way,  do  you 
not  agree  with  me  that  it  is  worth  while  and  worth  spending  some  of  our  money  to  do  it? 

Dr.  MoxGAx.   It  might  be. 

Mr.  Graham.  That  is  all  I  want  to  ask. 

The  Chairman'.  Are  there  any  other  members  of  the  committee  who  desire  to  ask 
the  doctor  any  questions? 

Mr.  Sanders.  With  reference  to  the  work  of  the  physicians'  organization  and  what 
they  are  accomplishing,  will  you  again  enumerate  some  of  the  diseases  that  they  haA"c 
helped  to  eliminate? 

Dr.  MoxGAX.  Diphtheria. 

Mr.  S.VNDKRS.   Diphtheria?     What  else  did  you  mention? 

Dr.  MoNGAN.  Smallpox. 

Mr.  Sanders.  And  what  else — yellow  fever? 

Dr.  MoNGAN.  Yes. 

Mr.  Sanders.  Malaria? 

Dr.  Morgan.  Yes. 

Mr.  Sanders.  Four  diseases.  Now,  is  it  not  a  fact  that  in  accomplishing  this  work 
with  reference  to  those  diseases  governmental  agencies  have  been  used  effectively? 


I 


120  PUBLIC  PKOTECTflON   OF   MATERNITY  AND   INFANCYi 

Dr.  MoNGAN.  Governmental  aids?    Yes. 

Mr.  Sanders.  So  that  it  was  by  the  cooperation  of  the  Government  on  the  one 
hand  and  of  the  mecjical  profession  on  the  other  hand  that  these  results  have  been 
accomplished  with  reference  to  the  spread  of  these  diseases? 

Dr.  MONGAN.  Yes — when  they  became  public,  not  when  they  were  individual 
matters;  not  when  they  became  diseases  of  the  individual.  When  they  became  a 
public-health  matter.  We  do  not  think  that  maternity  benefit  has  become  a  public- 
health  matter.  Malaria  and  smallpox  were  injurious  to  the  community,  in  the  same 
way  that  a  criminal  might  be  injurious  to  the  community. 

Mr.  Graham.  Will  you  speak  a  little  louder,  please,  Doctor? 

Dr.  MoNGAN.  I  said,  when  they  became  public-health  measures  and  were  a  menace 
to  the  public.  As  I  told  you  in  the  beginning,  we  do  not  object  to  the  exercise  of 
what  is  commonly  called  police  powers  of  the  State  when  the  emergency  arises.  I 
do  not  think  anybody  will  find  any  fault  with  the  Public  Health  Service  going  down 
into  the  mountains  just  to  the  south,  in  West  Virginia  and  Tennessee,  and  dealing 
with  trachoma  and  dealing  with  those  diseases  that  become  public-health  matters 
instead  of  individual-health  matters. 

Mr.  Sanders.  Have  you  finished,  Doctor? 

Dr.  MoNGAN.  I  was  going  to  say  that  when  governmental  aid  came  it  came  at 
the  request  of  the  physicians  who  dealt  with  the  cases,  when  they  felt,  in  justice  to 
the  community  and  themselves — and  they  are  always  self-sacrificing  and  will  not 
refrain  from  asking  the  Government  to  do  that,  but  nobody  has  come  here  for  the 
medical  profession  asking  for  this. 

Mr.  Sanders.  I  might  differ  with  you  on  that  proposition. 

Dr.  MoNGAN.  Yes;  you  might. 

Mr.  Sanders.  And  I  might  sustain  my  position  by  the  record,  too,  as  far  as  that  is 
concerned.  But  what  I  am  driving  at  is  that  you  recognize  it  as  a  proper  governmental 
function  to  give  proper  aid  in  the  preservation  of  the  life  of  the  Government's  citizens? 

Dr.  MoNGAN.  I  recognize  under  those  conditions  the  exercise  of  the  police  powers 
of  the  Government  in  any  necessity,  whether  it  is  health  or  any  other  necessity. 
That  is  what  I  recognize, 

Mr.  Sanders.  Then,  of  course,  the  sole  question  is  whether,  since  that  is  a  govern- 
mental function,  this  will  carry  out  that  governmental  function. 

Dr.  MoNGAN.  That  is  all.  It  is  a  proper  means  for  the  Government  to  exercise  its 
police  powers  in  carrying  out  the  preservation  of  the  lives  of  the  inhabitants  of  the 
United  States. 

Mr.  Sanders.  That  is  true,  but  what  I  asked  you  was  if  this  is  not  true,  that  the 
question  that  is  presented  to  this  committee  is,  according  to  your  views,  whether  or 
not  it  is  in  furtherance  of  the  governmental  function  to  help  preserve  the  lives  of  its 
citizens  to  enact  this  legislation. 

Dr.  MoNGAN.  I  think  it  is  not  necessary. 

Mr.  Sanders.  It  is  your  opinion  that  it  does  not  further  that  object? 

Dr.  MoNGAN.  Yes;  I  think  it  does  not. 

Mr.  Ha  WES.  Doctor,  you  are  not  opposed  to  a  State  insane  asylum,  operated  by  the 
State  for  the  poor  people? 

Dr.  MoNGAN.  Or  for  any  other  kind  of  people;  that  is  another  exercise  of  the  police 
power  of  the  State. 

Mr.  Ha  WES.  And  you  are  not  opposed  to  a  State  hospital  for  the  poor? 

Dr.  MoNGAN.  No;  that  is  another  exercise  of  the  police  power. 

Mr.  Hawes.  Or  a  city  dispensary  for  the  poor? 

Dr.  MoNGAN.  Certainly  not. 

Mr.  Sanders.  Pardon  me;  the  last  question  I  heard  was  with  reference  to  the 
Government  hospitals,  and  I  did  not  get  the  doctor's  answer. 

Mr.  Hawes.  I  will  repeat.  You  are  not  opposed  to  a  State  insane  asylum  to  handle 
the  insane  citizens  at  the  expense  of  the  State,  Doctor? 

Dr.  MoNGAN.  No,  sir. 

Mr.  Hawes.  Nor  to  the  city  hospital  which  takes  care  of  the  sick  poor? 

Dr.  MoNGAN.  No,  sir. 

Mr.  Hawes.  Nor  to  the  city  dispensary  to  care  for  the  temporary  needs  of  the  sick 
poor? 

Dr.  Mongan.  No,  sir. 

The  Chairman.  Is  that  all?  Does  any  other  member  of  the  committee  desire  to 
ask  any  questions?  If  not,  Doctor,  we  will  excuse  you,  and  we  are  obliged  to  you 
for  your  testimony. 

Dr.  Mongan.  I  thank  you  very  much. 

The  Chairman.  The  next  witness  to  be  called  is  Dr.  Quessy.  The  Chair  will  be 
obliged  to  advise  you,  Doctor,  that  there  are  only  10  minutes  left  in  which  you  can 
present  your  case,  unless  you  appear  at  a  later  time. 


I 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  121 

STATEMENT   OF   AliFRED   H.    QUESSY,   M.    D.,    FITCHBURG,    MASS. 

Dr.  QuESSY.  Mr.  Chairman,  I  really  will  not  be  able  to  say  all  the  thingfi  I  would 
like  to  say  in  so  short  a  time,  but  there  is  one  thing  I  want  to  emphasize.  1  believe  it 
needs  emphasis,  from  what  I  have  listened  to. 

Gentlemen,  you  must  make  a  distinction  between  public  health  and  individual 
health.  What  is  public  health,  and  what  is  individual  health?  Why  did  public 
health  come  into  existence?  Public  health  came  into  existence  because  of  public 
necessities,  the  conditions  of  disease  affecting  not  the  health  of  the  individual  but  the 
health  of  the  community  as  a  whole — such  diseases  as  smallpox,  diphtheria,  scarlet 
fever,  measles,  anthrax,  yellow  fever,  syphilis,  tuberculosis— any  and  all  diseases 
which  are  a  menace  to  the  health  of  the  community  as  a  whole  and  against  which 
the  community  can  not  guard  itself  against  except  through  Federal  aid  or  State  aid 
or  municipal  aid. 

In  contradistinction  you  have  individual  health;  that  is,  conditions  affecting  the 
health  of  the  individual  himself  or  herself.  And  these  conditions  vary.  They  are 
not  the  same.  The  dangers  are  to  the  individual,  not  to  the  community.  Each  indi- 
vidual case  requires  particular  and  individual  care.  Now,  gentlemen,  if  you  do  not 
make  that  distinction  in  handling  this  problem,  in  handling  all  your  health  problems, 
you  will  not  have  any  more  facility  in  arriving  at  a  solution  than  you  will  have  in  the 
present  one  concerning  maternity  legislation.  Soon  you  will  have  all  diseases  and 
conditions,  housing,  feeding,  clothing,  old  age  pensions,  every  and  all  social  measures 
classed  as  public  health  measures.  Your  troubles  are  only  beginning.  This  would 
be  paternalism  or  socialism. 

Public  health  problems  alone  are  within  your  province,  and  physicians  stand  for 
that.  We  stand  behind  it;  we  want  governmental  aid  in  regulating  conditions  which 
affect  the  health  of  the  community  as  a  whole.  We  need  you,  we  must  have  you,  but, 
gentlemen,  I  say  that  when  it  comes  to  regulating  individual  conditions,  individual 
health  problems,  it  is  not  your  province,  you  are  not  able  nor  competent  to  do  so. 
It  belongs  to  the  individual  health  service,  to  the  individual  practitioner  of  medicine, 
who  goes  out  from  house  to  house  and  meets  these  individual  conditions,  who  is  brought 
into  contact  with  these  individual  conditions,  who  must  treat  these  individual  con- 
ditions. 

And  amongst  individual  health  problems,  gentlemen,  is  the  maternity  situation. 
A  pregnant  woman  is  not  contagious.  This  is  an  individual  health  problem.  Her 
dangers  are  to  herself,  not  to  the  community.  Each  particular  woman  varies  in  her 
condition.  You  can  not  set  any  fixed  rule  which  is  going  to  govern  every  single 
woman.  Each  woman  varies,  and  each  particular  woman  must  be  under  the  par- 
ticular care  of  this  or  that  particular  physician,  because  her  condition  will  be  such 
that  it  must  be  watched.  The  conditions  arising  must  be  followed,  and  arrested 
then  and  there  by  individual  health  service,  absolutely  not  by  governmental  nor 
State  nor  municipal  authority. 

Now,  you  raise  a  question.  You  say  let  the  Government  help  in  these  things. 
Y^es,  in  public  health  matters.  In  individual  health  matters,  no.  Keep  close  to 
the  line  and  you  can't  go  wrong.  Gentlemen,  you  say,  ''Is  not  the  Government  the 
proper  agency  to  do  this  work?  Don't  you  believe  that  the  Government  ought 
to  do  this?  "  I  believe  the  Government  ought  to  do  the  things  that  it  ought  to  do  and 
nothing  more.     The  Government  is  not  the  proper  agency  fot  individual  health 

i  service.     Better,  more  competent  and  satisfactory  service  would  be  rendered  the 

i  public  by  adhering  strictly  to  public  health  work.     Kender  unto  Csesar  that  which 

1  IS  Osesar's. 

The  Government  has  taken  upon  itself  the  care  of  our  disabled  soldiers,  and  has  not 

;  shown  the  competency  to  do  what  ought  to  be  done  for  the  soldiers.     Gentlemen,  if 
we  are  to  entrust  to  the  Government  the  care  of  our  wives  and  our  mothers  and  our 

!  daughters,  and  if  we  are  going  to  expect  that  same  competency  that  is  being  given  to 

j  the  disabled  soldiers,  then  I  ask  you  not  to  take  care  of  our  wives  and  mothers  and 

I  daughters;  leave  it  to  us. 

The  medical  profession  is  on  the  job.  We  have  been  on  the  job,  and  will  be  in  the 
future.  No  one  can  deny  it.  Conditions  are  not  as  bad  as  brought  before  you.  Mis- 
statements have  been  made  to  enlist  your  sympathy.  There  is  no  necessity  for  this 
legislation.  It  is  simply  an  effort  to  legislate  something— you  know  that  as  well  as  I 
do.  This  bill  before  you  is  nothing  but  a  boiled  down,  concentrated  thing,  not  what 
was  originally  brought  before  you.  What  was  brought  before  you  formerly  was  a 
regular  plan  ot  social  insurance,  and  that  was  so  repugnant  and  met  mth  so  much 
opposition  that  it  has  dmndled  down  by  amendment  after  amendment,  so  that  to-day 
you  have  nothing  left  but  a  plan  to  go  out  and  give  advice  and  instruction.     This  bill 


122  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

if  passed  will  be  the  foundation  upon  which  to  build  the  future  structure  of  social 
insurance. 

Now,  gentlemen,  you  can  not  give  advice  and  instruction  by  wholesale  to  cover 
individual  cases.  One  must  be  on  the  spot,  and  nobody  is  better  qualified  than  the 
medically  trained  man  to  give  advice  and  instructions. 

Proponents  can  tell  you  those  things,  but  they  can  not  tell  us.  We  know  what 
we  are  talking  about  when  we  talk  about  maternity  conditions.  Gentlemen,  this  bill 
is  not  what  it  was  intended  to  be,  and  if  the  proponents  can  only  get  you  to  pass  it, 
it  will  serve  as  an  entering  wedge  upon  which  they  intend  to  build.  If  you  subscribe 
to  this  you  must  subscribe  to  the  whole  control  of  the  practice  of  medicine  because 
obstetrics  is  only  a  part  of  general  medicine. 

If  you  are  going  to  take  on  new  responsibility  under  this  bill,  if  you  are  going  to  take 
care  of  my  children,  if  you  are  going  to  take  care  of  my  parents,  if  you  are  going  to  take 
care  of  my  wife,  you  must  conscientiously  take  care  of  me  just  as  well,  because  I  am 
supposed  to  produce  as  well  as  any  other  person,  I  deserve  help  as  well  as  anybody 
else,  and  every  citizen  in  this  country  can  say  the  same.  And  if  you  are  going  to  start 
on  this  thing,  if  you  are  going  to  start  on  maternity  aid,  then  you  might  just  as  well  fur- 
nish aid  in  paying  the  house  rent,  in  paying  the  grocery  bills,  in  clothing  the  people. 
So  it  is  nothing  but  paternalism,  and  proponents  tell  you  it  is  a  needed  measm-e.  It 
is  not  needed,  and  nobody  can  show  me  that  it  is  needed.  I  will  show  you  that  it  is 
not,  if  I  have  the  time  to  do  it.  I  will  show  you  the  fallacy  of  the  evidence  submitted 
to  you.  This  is  a  paternalistic  measure,  pure  and  simple.  It  is  asking  you  to  do  what 
the  father  of  a  family  should  do.  When  a' man  gets  married,  he  takes  upon  himself 
the  responsibilities  of  a  married  man,  and  should  he  come  before  Congress  to  ask  you 
to  pay  his  bills,  to  ask  you  to  do  what  he  should  do? 

No,  gentlemen,  this  whole  measure  is  purely  paternalism.  If  you  start  in  on  this 
thing,  there  is  no  end  to  it.  And  if  you  start,  have  a  reason  to  start,  at  least.  You  have 
no  reason.  I  say  conditions  are  not  as  bad  as  has  been  stated,  and  I  can  prove  my 
statements.  The  medical  profession  is  an  organized  body,  with  all  the  machinery 
necessary — ^medical  men,  medical  associations,  medical  schools,  educators,  hospitals, 
trained  staff  corps  of  hospitals,  associated  with  visiting  nurse  associations.  There  is 
the  machinery,  just  as  good  as  anything  you  can  create.  If  the  Government  has  any 
special  qualifications  to  do  better  than  we,  I  want  to  know  what  they  are. 

You  have  never  had  any  experience.  What  qualifications  can  you  show  me  to  in- 
dicate that  you  can  do  better  than  we  have  done?  We  have  been  saving  lives.  It  is 
our  work.  We  know  about  it.  What  do  you  know  about  it?  What  qualifications 
have  you?  You  say  you  want  to  do  it.  What  qualifications  have  you?  I  want  to 
know. 

Gentlemen,  the  medical  profession  is  organized  to  do  preventive  work  through  its 
societies.  I  want  to  tell  you  that  the  American  Medical  Association,  composed  of 
members  throughout  the  whole  United  States,  affiliated  with  all  the  different  State 
societies,  has  entered  upon  a  program  to  outline  a  plan  of  cooperation  between  the 
physicians  of  all  States,  societies,  hospitals,  organizations  of  nurses,  other  organizations, 
and  the  public  to  do  this  work.  And  I  tell  you  they  can  do  it  better  than  you,  with 
all  due  respect  to  whatever  opinion  you  may  have. 

I  wish  I  could  talk  longer  than  10  minutes,  but  I  want  to  leave  with  you  the  fact  that 
this  is  not  a  public-health  measure,  and  if  you  start  on  individual  health  measures  you 
can  not  stop.  It  is  wiser  not  to  start.  There  is  no  reason  for  you  to  stop  when  once  you 
have  started. 

Make  a  distinction,  not  only  in  this  matter  but  in  all  future  matters  of  Government 
health  activities,  whether  it  is  Federal,  State,  or  municipal.  You  have  got  to  jnake 
the  distinction  and  draw  the  line;  on  one  side  public-health  measures,  which  is  your 
job;  on  the  other  side,  individual  health  measures,  which  is  not  your  job.  If  you 
want  to  leave  your  job  to  take  up  our  job,  you  are  going  to  have  yoiu-  hands  full,  and 
you  are  not  going  to  succeed  any  more  than  you  have  succeeded  in  any  other  private 
Government  enterprises. 

Gentlemen,  have  you  any  questions?  I  would  like  to  answer  your  questions  if  I 
have  the  time, 

Mr.  Reyburn.  Doctor,  would  you  object  to  this  proposition  just  the  same  if  it  were 
to  be  administered  by  the  Public  Health  Service? 

Dr.  QuESSY.  Absolutely,  because  it  is  not  a  public-health  measure.  It  belongs  to 
the  individual  health  service;  that  is  where  it  belongs,  where  it  is  now,  and  where  it 
ought  to  be,  and  where  it  will  be  done  better  than  under  any  other  service. 

Mr.  Rayburn.  Your  idea  is  that  the  function  of  the  Public  Health  Service  is  to 
guard  the  community  and  the  public? 

Dr.  Quessy.  The  public,  the  community  as  a  whole.  Unfortunately,  there  is  a 
danger  of  departing  from  that,  and  to  that  danger  I  call  your  attention.     Do  not  let 


PUBLIC   PllOTEOTION    OF    MATERNITY   AND    INFANCY.  123 

yoursclvoH  be  wworvcd  by  that  toiKloncy;  if  you  do,  you  are  going  to  have  a  lot  of 
difiic'ulties  confront  yon  in  the  next  few  yearw. 

Mr.  lIocH.  Doctor,  the  fundamental  principle  that  yon  have  laid  down  here,  the 
distinction  you  have  drawn  between  public  health  and  individual  health,  would 
of  course  i)reclude  any  such  work  as  that  done  in  New  York  City,  would  it  not? 

Dr.  Qup;ssv.  No;  on  the  contrary.  I  take  that  as  an  argument,  sir,  in  our  favor. 
What  is  done  in  New  York  ( 'ity  is  done  under  individual  enterprise.  They  come  here 
and  call  attention  to  their  work,  })ecause  they  want  to  turn  it  over  to  Federal  aid. 
They  are  doing  their  work  under  indi\idual  enter'|)ri8e. 

Mr.  llocii.  You  have  hud  down  a  ])rinciple  as  to  the  functions  of  government, 
including  municii)al.  State,  and  I^'ederal  (Jovernments,  holding  that  the  function  of 
government  was  solely  with  reference  to  what  you  call  public  health  matters,  matters 
in  which  the  health  of  the  community  is  jeopardized  by  some  contagious  disease, 
for  instance? 

Dr.  QuEssv.  That  is  as  it  should  be;  yes,  sir. 

Mr.  HocH.  And  when  it  goes  to  the  matter  of  purely  individual  ailments  or  anything 
of  that  sort,  the  individual  person  with  reference  to  his  own  health,  that  is  a  matter 
in  which  no  governmental  agency  should  take  any  part,  because  it  is  solely  individual 
and  that  should  be  left  entirely  to  the  medical  profession?  That  is  the  distinction 
you  make? 

Dr.  QuES-sY.  Absolutely,  sir;  and  the  time  the  physicians  fail  to  do  that  work 
then  is  your  time  to  step  in. 

Mr.  ifocH.  Just  a  moment.  Doctor.  I  recognize  very  plainly,  we  all  do,  the  dis- 
tinction you  are  drawing.  Now,  I  am  asking  you  if  your  distinction,  applied  logically, 
would  not  prevent  an}'  such  work  as  has  been  done  in  New  York  City,  because  it  is 
done  with  reference  to  information  given  to  individual  prospective  mothers  and  is 
plainly  in  opposition,  it  seems  to  me,  to  the  principle  you  have  laid  down.  To  be 
logical,  it  seems  to  me  >'ou  would  have  to  hold  that  that  was  not  a  proper  function 
of  the  municipal  government. 

Dr.  QuEssY.  We  are  not  opposed  to  what  is  being  done  in  New  York  City.  I 
approve  of  it;  I  compliment  them  upon  it. 

Mr.  lIocH.  But  how  do  you  harmonize  your  statements,  Doctor? 

Dr.  QuEssY.  Because  it  is  individual.  It  is  under  neither  municipal,  State,  nor 
Federal  control,  unless  I  am  misinformed. 

Mr.  IJocH.  You  are  mistaken;  it  is  under  the  municipal  government.  The  depart- 
ment of  public  health  of  New  York  City 

Dr.  QuKssY.  There  are  two  departments  there;  the  board  of  health,  which  is  run- 
ning the  child  welfare  clinic,  and  the  maternity  center,  which  is  not  under  municipal 
control. 

Mr.  lIocH.  I  am  sure  you  are  misinformed  about  that;  that  is  not  correct. 

Dr.  QuEssY.  I  take  my  information  from  the  report  of  the  New  York  City  Maternity 
Center  Association.  Please  read  first  page,  lines  19  to  28.  Reprinted  from  the 
transactions,  tenth  annual  meeting  American  Child  Hygiene  Association,  1919.  But, 
to  cut  out  ail  argument,  I  do  not  care  what  results  they  have  had  in  New  York,  nor 
by  what  means.  That  does  not  prove  that  we  can  not  do  the  whole  thing  in  this  whole 
Nation  without  governmental  aid.     Show  me  that  we  can  not. 

Mr.  HocH.  I  do  not  think  you  apprehend  either  the  spirit  or  the  purpose  of  my 
question.  You  have  raised  a  distinction  here.  I  am  not  combating  your  position, 
although  I  may  not  agree  with  it;  but  you  have  drawn  a  plain  distinction  between 
public  health  and  individual  health,  and  you  have  stated  tliat  public  health  solely 
is  a  matter  for  governmental  agencies  to  participate  in . 

Dr.  QuE.ssY.  I  do. 

Mr.  HocH.  Now,  I  am  saying  that  the  evidence  here  is  that  in  New  York  City, 
under  the  department  of  health,  they  have  engaged  in  a  very  broad  way  in  the  matter 
of  information  to  individual  prospective  mothers,  in  the  matter  of  prenatal  care  and 
things  of  that  sort,  and  testimony  has  been  given  here  with  reference  to  the  benefits 
of  that  particular  thing. 

Now,  is  it  not  true,  as  a  logical  proposition,  if  you  are  correct  in  your  fundamental 
basis,  that  that  work  being  done  in  New  Y'ork  City  with  reference  to  prenatal  care  and 
matters  of  that  sort,  being  solely  a  matter  relating  to  individual  health  and  not  to  some- 
thing that  is  contagious,  you  wo.uld  have  to  say,  however  much  good  it  may  do,  that 
you  do  not  think  it  ought  to  be  done  by  the  Department  of  Health  of  New  York  City? 

Dr.  QuEssY.  I  wilfanswer  that  by  saying  that  I  believe  the  work  done  by  the 
New  York  Maternity  Center  has  established  that  cooperation  can  l)e  created  between 
physicians,  laymen,  nurses,  and  the  public,  and  good  results  can  be  obtained,  as  has 
been  done  in  New  York  City,  without  or  prior  to  governmental  interference,  and  that 
proves  my  contention  that  this  bill  before  you  is  wholly  unnecessary  and  unwarranted . 
(Thereupon,  at  11.05  o'clock  a.  m.,  the  committee  adjourned  to  meet  at  9. .SO  o'clock 
a.  m.  to-morrow.  Thursdav.  Julv  21,  1921.) 


124  PUBLIC   PEOTECTION    OF   MATERNITY   AND   INFANCY, 

Committee  on  Interstate  and  Foreign  Commerce, 

House  op  Representatives, 

Thursday,  July  21,  1921. 

The  committee  met  at  9.30  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman) 
presiding. 

The  Chairman.  If  the  members  of  the  committee  will  come  to  order,  we  will  pro- 
ceed with  the  hearing  on  the  bill  now  before  us. 

Mr.  Sanders.  Mr.  Chairman,  in  order  to  correct  the  record  made  the  other  day,, 
may  I  have  about  half  a  minute? 

The  Chairman.  Yes. 

Mr.  Sanders.  I  was  called  to  the  telephone,  and  I  asked  Judge  Webster  to  put  in 
the  record,  by  cross-examination  of  the  witness,  the  number  of  physicians  who  were 
employed  by  the  Children's  Bureau.  The  list  which  was  then  put  in  is  a  correct 
list  of  the  physicians  that  have  been  employed.  However,  there  are  now  only  the 
following  physicians  employed:  Dr.  Florence  McKay,  Dr.  Ella  Oppenheimer,  Dr. 
Frances  Sage  Bradley,  and  Dr.  Anna  E.  Rude  in  Washington,  and  Dr.  Dorothy  Reed 
Mendenhall  is  on  the  staff,  but  is  not  stationed  in  Washington. 

The  Chairman.  Gen.  Sawyer,  if  you  will  kindly  appear  as  a  witness  now,  we  can 
perhaps  finish  with  your  testimony  this  morning. 

Gen.  Sawyer.  I  appreciate  that  very  much,  sir. 

STATEMENT  OF  BRIG.  GEN.  C.  E.   SAWYER,  WASHINGTON,  D.  C. 

The  Chairman.  Give  your  name  and  position,  and  anything  else  you  want  to  say 
to  identify  yourself. 

Gen.  Sawyer.  I  am  Dr.  C.  E.  Sawyer,  of  Washington,  D.  C. 

The  Chairman.  General,  you  perhaps  are  not  entirely  clear  as  to  just  the  infor- 
mation the  committee  would  like  particularly  to  get  from  you,  as  well  as  any  general 
or  direct  views  you  may  have  on  this  bill  now  before  us,  which  is  the  so-called 
Sheppard-Towner  bill,  with  which  you  are  undoubtedly  familiar. 

Gen.  Sawyer.  Yes,  sir. 

The  Chairman.  In  behalf  of  the  committee,  and  as  a  leader  for  your  thought  and 
testimony,  the  chairman  would  like  to  ask  you  if  you  have  considered  about  where 
in  your  scheme  of  a  welfare  department  which  we  have  submitted  to  us  you  would 
expect  the  functions  or  the  work  proposed  by  this  bill  to  be  located,  and  we  would 
like  to  have  a  further  statement  as  to  whether  or  not  if  the  bill  passed  as  now  before 
us,  at  a  reasonably  early  time,  before  the  welfare  department  might  have  been  estab- 
lished, there  would  be  any  annoying  conflict  in  the  development  of  the  general 
department.  There  are  two  questions  there,  one  as  to  where  you  would  expect  it 
to  fit  in,  and  the  second  one,  whether  or  not  for  the  purposes  of  your  department  there 
is  need  of  haste  or  objection  to  haste. 

Gen.  Sawyer.  Mr.  Chairman,  naturally,  sir,  this  would  come  to  the  welfare  depart- 
ment. I  can  see  nothing  in  the  bill  that  would  in  any  way  prevent  its  final  allocation 
to  the  welfare  department.'  I  have  great  confidence  in  the  people  who  have  in  mind 
the  administration  of  these  affairs.  I  think  I  am  safe  in  assuming  that  they  are  in 
accord  with  our  own  ideas  as  to  how  this  would  finally  be  best  handled.  I  am  sure 
we  are  all  in  accord  as  to  the  importance  and  necessity  of  the  measure,  and  the  effec- 
tiveness of  it,  and  there  seems  to  be  no  reason,  sir,  why  there  should  be  any  mis- 
understanding or  any  disturbance  in  any  way,  if  this  bill  should  be  passed  now,  in 
the  final  and  proper  handling  of  the  matter  in  such  department  as  we  are  sure  will 
be  finally  provided  for  the  reception  and  disposition  of  such  matters.  I  do  not  know 
whether  that  answers  your  questions  or  not. 

The  Chairman.  Yes;  I  think  that,  in  general,  is  an  answer  to  the  question.  If 
this  work  were  to  be  assigned  to  the  Children's  Bureau,  as  contemplated  by  the  bill, 
I  judge  from  the  charts  which  accompanied  your  brief  it  would  go  under  the  immediate 
direction  of  an  assistant  secretary  of  the  cabinet  having  charge  of  the  welfare  bureau 
under  whom  social  service,  as  a  broad  proposition,  would  fall. 

Gen.  Sawyer.  Yes,  sir. 

The  Chairman.  If  it  should  go  to  the  bureau  of  the  public  health,  as  some  advocate, 
it  would  go  to  a  different  assistant  secretary. 

Gen.  Sawyer.  Yes,  sir;  that  would  be  true. 

The  Chairman.  Can  you  see  any  reason  for  a  modification  of  the  terms  of  the  bill 
as  it  is  now  priestented  to  us  for  consideration  in  the  event  of  its  going  to  the  Public 
Health  Service  rather  than  to  the  Children's  Bureau  in  order  to  fit  into  the  scheme? 

Gen.  Sawyer.  My  feeling  about  the  bill  is  this,  sir.  This  really  is  a  sociological 
subject.  I  believe  it  belongs  to  the  social  sevice  division  of  the  new  welfare  de- 
partment.    I  can  readily  understand  how  there  might  be  some  differences,  perhaps, 


PUBLIC   PROTECTION   OF    MATERNITY   AND   INFANCY,  125 

■of  opinion  as  1,0  juHl  what  ])art  of  this  work  should  be  handled  by  thi8dei)artn.ent  or  by 
the  Public  Health,  but  there  should  be  no  reason  why  there  should  not  be  a  hearty 
cooperation  between  the  Public  Health  Service,  from  the  doctor's  standpoint,  and 
the  social  serivce  department,  from  the  sociological  standj)oint.  It  is  very  easy  to 
make  the  whole  matter  fit  perfectly  as  1  see  it. 

The  Chairman.  Do  you  see  the  opportunity  for  so  doing  under  the  provisions  of 
this  bill? 

Gen.  Sawyer.  To  be  frank  with  you,  sir,  I  am  not  quite  familiar  with  bills  and 
bill  making  to  pass  an  opinion  on  that  subject.  In  the  formation  of  all  bills  I  have 
always  left  the  matter  of  bill  making  to  those  who  are  experienced  in  that  work. 
I  have  been  led  to  believe  that  there  was  nothing  in  the  bill  that  would  interfere  with 
that  sort  of  an  arrangement.  That  being  true,  then  I  would  say  that  1  would  favor 
the  bill  as  it  exists,  and  then  1  should  say  that  in  the  construction  of  the  bill  such 
arrangement  ought  to  be  made  as  to  leave  no  question  as  to  what  ultimately  would 
become  of  the  measure. 

The  Chairman.  The  chairman  is  a  little  bit  at  sea  to  know  how  to  proceed,  Doctor, 
in  view  of  the  fact  you  disclaim  familiarity  with  the  bill,  and  I  have  no  desire  to  lead 
you  in  any  direction  other  than  to  get  your  views  on  the  matter,  but  the  bill  does 
provide,  in  a  general  way,  and  I  will  not  be  so  specific  as  to  annoy  you,  to  have  the 
plans  of  the  Children's  JBureau,  if  the  bill  were  to  pass,  worked  out  through  estab- 
.lished  organizations  of  public  health  or  something  of  the  kind  in  the  several  States. 

Gen.  Sawyer.  Yes. 

The  Chairman.  Do  you  think  there  would  be  any  danger  of  any  conflict,  possibly 
■of  authority  or  of  jurisdiction  or  of  practice  by  virtue  of  having  the  Children's  Bureau 
from  Washington  direct  by  approval  the  operations  of  the  board  of  health  in  Kansas, 
let  us  say,  in  the  maternity  department  and  the  Public  Health  Service  from  Wash- 
ington directing  other  health  movements  in  considerable  numbers  through  the  same 
■department? 

Gen.  Sawyer.  I  can  see  no  reason  why  that  should  exist  or  why  there  should  be 
;any  difficulties  in  the  States.  I  might  say  this:  It  is  my  feeling  that  it  is  very  import- 
.ant  indeed  that  we  should  properly  safeguard  the  allotment  of  money  to  States.  I 
can  see  in  this  bill  some  liability  to  abuse  in  that  regard,  but  so  far  as  the  operation  of 
the  affairs  is  concerned,  I  can  see  no  reason  why  this  bill  as  it  reads  should  not  be 
■carried  out. 

The  Chairman  .  Suppose  we  take  a  hypothetical  case  in  order  to  illustrate  the  matter 
and  let  us  suppose  there  is  a  family  in  distress  in  Kansas  which  the  board  of  health, 
under  the  i)owers  already  assigned  to  it,  is  treating,  and  we  will  say  that  the  mother, 
in  order  to  illustrate  and  to  get  home  to  this  bill,  is  under  the  direction  and  care  of  the 
Public  Health  Service,  let  us  say,  for  tuberculosis  or  syphilis  or  both.  On  comes  the 
prospective  motherhood,  and,  acting  under  the  direction  of  the  Children's  Bureau 
from  Washington,  some  organization  or  another  proceeds  to  that  family  by  arrange- 
ment made  with  Washington  to  take  up  the  maternity  case,  and  suppose  they  were 
not  the  same  organization  but  two  different  organizations.  Would  it  be  possible  for 
a  conflict  of  authority  to  result  in  possibly  two  lines  of  treatment  in  view  of  the  fact 
that  two  agencies  were  working  on  that  same  patient? 

Gen.  Sawyer.  There  should  be  none.  If  I  understand  the  meaning  of  this  whole 
bill,  the  agency  representing  the  Public  Health  has  to  do  with  the  things  that  affect 
the  illness  of  this  patient.  This  bureau,  as  I  understand,  has  in  mind  building  up 
an  organization  that  is  quite  as  responsible  and  is  to  have  its  responsibility  to  the 
same  central  authority  in  Washington  as  the  Public  Health  Service.  That  being  true, 
there  should  be  no  misunderstanding  between  the  Public  Health  Service  and  the  per- 
sons operating  under  the  requirements  of  this  bill. 

The  Chairman.  Now,  suppose,  for  instance,  in  the  State  of  Kansas,  which  I  will  use 
■only  to  illustrate,  it  turned  out  that  the  Children's  Bureau  saw  fit  to  make  its  arrange- 
ment with  the  Washington  organization  for  the  administration  of  its  work  and  the 
public  health  was  working  with  them  and  you  come  back  to  the  same  case  I  have  men- 
tioned ,  and  each  one  undertakes  to  carry  out  its  own  suggestions  as  to  the  care  of  the 
patient,  as  to  habits  of  living,  medical  treatment,  and  so  on,  would  you  feel  that  there 
might  not  perhaps  be  a  conflict  there? 

Gen.  Sawyer.  I  should  say  in  answer  to  that,  sir,  that  if  there  is  a  disposition  on 
the  part  of  the  public  health  toward  that  of  social  service  to  drive  a  wedge  between 
them  anywhere  or  if  there  is  other  than  the  kindliest  feeling,  it  would  not  be  effectual, 
no  matter  where  it  was  handled.  It  seems  to  me  it  is  quite  important  that  public 
health  should  understand  that  this  is  given  to  the  social  service  section  of  the  Govern- 
ment to  administer  the  affairs  that  are  laid  down  in  this  bill,  and  I  can  see  no  reason 
why  there  should  not  be  conference  and  sympathetic  understanding  between  them, 
and  I  can  not  see  whv  there  should  arise  differences.     I  am  frank  to  sav  that  I  have 


126  PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY. 

made  some  observations  that  lead  me  to  believe  that  that  spirit  is  existing  at  present, 
and  I  am  distressed,  sir,  to  know  that  such  is  the  case. 

The  Children's  Bureau  and  the  Public  Health  Service  could  readily  come  to  a 
more  general  understanding  whereby  there  would  be  no  differences. 

The  Chairman.  That  is  the  condition,  of  course,  that  is  desired,  but  suppose  the 
case  were  reversed  and  the  Public  Health  Service  had  been  treating  the  prospective 
mother  for  some  time  and  the  case  would  seem  to  be,  speaking  in  an  offhand  way,  a 
public  health  case,  and  along  comes  the  officer  in  charge  of  the  Children's  Bureau  and 
agrees  to  take  up  that  case,  then,  would  it  be  a  case  for  the  Public  Health  Ser\dce? 

Gen.  Sawyer.  The  Public  Health  Service  would  have  charge  of  the  case.  I  am 
not  trjdng  to  impress  you  or  anyone  else  that  all  of  the  yielding  should  be  on  the  side 
of  the  Public  Health  Service.  I  am  not  for  that.  I  am  for  a  mutual  understanding 
by  which  the  two  services  can  go  along,  hand  in  hand  and  heart  to  heart,  to  accomplish 
what  this  bill  has  in  mind . 

The  Chairman.  At  least  one  member  of  the  committee,  I  myself,  after  some  expe- 
rience in  Washington,  have  come  pretty  firmly  to  the  conclusion  that  however  much 
we  might  desire  to  have  this  cooperation  between  the  departments  of  the  Govern- 
ment, it  does  not  seem  to  be  the  rule.  Each  one  by  tradition  or  practice  or  human 
nature  or  otherwise  seems  to  defend  its  own  prerogatives.  The  result  is  that  the  Chris- 
tian view  and  the  practical  view  which  you  fairly  represent  does  not  prevail  in  the 
work  of  the  departments.  If  there  is  anything  in  that  at  all  that  is  worth  while  con- 
sidering, would  you  feel,  on  the  whole,  that  a  bill  could  be  drawn  which  would  fairly 
accomplish  the  work  in  such  a  way  as  to  eliminate,  as  far  as  human  action  can  elimi- 
nate, the  possibility  of  conflict,  that  it  would  be  wise  to  so  draw  the  bill? 

Gen.  Sawyer.  If  there  is  any  question  in  the  mind  of  anyone  who  has  this  bill 
in  charge  that  there  are  going  to  be  these  things  which  you  have  in  mind,  these  lia- 
bilities, and  there  is  a  way  of  eliminating  them  in  the  bill,  certainly  it  would  be  good 
sense  to  make  such  alterations  in  the  bill  as  to  prevent  them.  Being  still  a  youngster 
in  Washington,  coming  from  the  Middle  West,  I  have  not  had  the  experience  to 
which  you  refer. 

The  Chairman.  I  respect  your  view,  in  respect  to  your  experience. 

Do  you  feel,  in  view  of  the  fact  that  the  health  of  these  patients  is  to  be  a  consid- 
eration in  respect  of  the  operation  of  this  bill,  should  it  become  a  law,  that  the  medical 
mind  should  direct  all  medical  considerations  which  enter  into  the  service  in  the 
execution  of  the  provisions  of  the  bill? 

Gen.  Sawyer.  Absolutely  so.  I  believe  that  all  things  pertaining  to  the  disease 
of  any  individual  in  a  community  relating  to  any  liability  to  the  community  belongs 
to  the  Public  Health  Service.  There  should  never  be  a  question  about  where  it 
belongs.     That  should  be  the  supreme  authority  under  every  and  all  circumstances. 

The  Chairman.  And  you  would  embody  the  maternity  consideration  in  that  general 
definiton  of  pubic  health? 

Gen.  Sawyer.  Absolutely  so. 

The  Chairman.  If  that  is  the  case,  would  you  feel  that  if  the  bill  were  passed  in 
some  form,  in  view  of  the  present-day  construction  of  the  personnel  of  the  Children's 
Bureau  or  any  other  construction  of  the  same  order,  that  there  should  be  a  distinct 
provision  for  a  medical  department  within  that  bureau  to  be  responsible  for  such 
matters  as  the  biu-eau  might  see  fit  to  undertake  involving  the  health  feature? 

Gen.  Sawyer.  I  can  hardly  see  the  necessity  of  such  an  arrangement;  no',  sir. 

The  Chairman.  Wherein  would  you  provide  for  the  Children's  Bureau  to  get  its 
inspiration  in  respect  of  the  health  work? 

Gen.  Sawyer.  It  must  get  its  inspii-ation  from  the  soul  that  inspii'ed  this  measure. 
As  I  say  to  you,  my  understanding  of  this  billis  that  it  handles  the  sociological  side. 
Do  I  make  myself  clear?  It  does  not  handle  the  medical  side  of  maternity.  It 
handles  the  social  relations,  it  handles  the  natural  conditions  that  stand  for  the  highest 
types  of  motherhood,  for  the  best  possible  preparatory  educational  care,  or,  I  should 
say,  precept  that  can  be  established.  That  is  my  understanding.  As  I  read  this  bill 
its  purpose  is  to  distribute  information,  and  as  I  interpret  the  bill  it  does  not  mean 
that  it  is  going  to  tell  Mrs.  Smith  how  she  shall  treat  some  disorder  that  she  may  have, 
but  it  is  only  to  teach  Mrs.  Smith  the  things  that  are  well  for  her  to  do  that  she  may  be 
in  the  best  physical  condition  to  meet  maternity  requirements.  If  Mrs.  Smith  has 
a  disorder,  such  as  comes  to  women,  that  requires  medical  treatment  and  medical 
attention,  certainly  those  in  charge  of  this  affair  would  not  attempt  to  treat  that  case 
medically.  If  there  is  any  way  in  which  this  bill  can  be  interpreted  to  mean  that  it 
gives  to  the  Children's  Bureau  the  power  to  treat  diseases  of  mothers  or  children, 
then  I  do  not  understand  it. 

The  Chairman.  I  think  your  premises  are  correct  as  far  as  you  go,  but  the  bill 
provides  that  none  of  the  financial  benefits  shall  be  forthcoming  unless  the  State 
subscribes  to  the  plans  and  ideas  of  the  central  board  here  in  Washington. 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY.  127 

GcMi.  Sawyeu.  Absolutely. 

The  Chairman.  Suppose  that  fj;oes  to  a  hoard  of  public  health  of  a  State,  that  board 
of  public  health  certainly  will  be  expected  to  exercise  some  judgment  in  respect  to  the 
medical  treatment  and  consideration  of  yiatients  in  that  State? 

Gen.  Sawyer.  Yes,  sir. 

The  Chairman.  It  it  should  happen  that  its  ideas  of  the  method  of  administering 
that  work  should  not  be  interwoven  with  the  ideas  of  the  (  hildren's  Bureau  under  the 
bill  the  bureau  here  in  Washington  would  have  authority  to  say,  "You  can  not  have 
any  money  until  you  change  your  scheme  and  come  around  to  our  way  of  thinking." 
Do  you  fee!  that  that  is  a  safe  proposition? 

Gen.  Sawyer.  Our  way  of  thinking  should  be  so  established  that  there  should  be  no 
desire  or  no  possibility  of  anybody  getting  around  it.  That  is  what  I  think  this  bill 
does  provide.  It  makes  it  possible  for  those  in  charge  of  the  affairs  in  Washington  to 
say  to  the  States  that  they  must  follow  and  unless  they  do  follow  the  plans  they  are  not 
entitled  to  have  money.  So  there  should  be  no  misunderstanding  as  to  what  is  to 
come  out  of  this  matter  when  it  goes  to  the  States.  The  State  is  given  rules,  regu- 
lations, and  legislative  procedure  and  it  is  told  that  if  it  accepts  those  things  that  it  is 
entitled  to  money.  Until  they  conform  to  these  requirements  they  have  no  right  and 
can  not  in  anyway  participate  in  the  central  arrangement.  With  such  central  direc- 
tion, if  we  can  solve  our  problems  and  stop  our  troubles  here  we  will  have  none  to  pass 
on  to  the  States. 

The  Chairman.  You  have  a  closely  centralized  authority  and  States  right,  and  so 
forth,  are  simply  wiped  out.  and  they  must  comform  to  whatever  Washington  deter- 
mines? 

Gen.  Sawyer.  Personally — I  am  speaking  personally — I  have  the  misfortune 
oftentimes  of  being  placed  in  the  position  of  speaking  for  the  President  of  the  United 
States.  Let  me  make  it  clear  that  I  am  speaking  for  Dr.  Sawyer.  Personally  I  have 
no  confidence  in  the  highest  accomplishment  of  State  relations  where  you  have  to  buy 
them  or  where  you  have  to  pay  them.  I  do  believe  that  this  board  by  setting  up  in 
Washington  an  exemplary  plan  of  handling  such  matters  will  impress  upon  every  State 
in  the  Union,  \^athout  paying  them,  the  importance  and  ad\'isability  of  pursuing  the 
plan  established.  Then  whether  they  accept  Federal  example  and  Federal  assistance, 
or  whether  they  carry  their  affairs  on  as  they  have  heretofore  under  their  own  admin- 
istration, is  a  matter  for  each  State  to  determine  for  itself. 

The  Chairman.  Of  course,  if  they  are  in  an  advisory  capacity  and  provide  money 
to  help  the  States  in  their  own  way  of  operating,  that  is  one  thing,  but  unless  they 
approve  no  money  is  given 

Gen.  Sawyer  (interposing).  I  understand. 

The  Chairman.  We  virtually  put  the  States  desiring  money  to  carry  on  the  service 
in  such  a  position  that  if  they  do  not  accept  Washington  they  can  not  get  the  money, 
and  thereby  the  power  of  the  State  to  carry  on  its  own  policy  would  be  absolutely 
eliminated. 

Gen.  Sawyer.  I  can  hardly  agree  with  you  on  that  matter,  and  as  a  reason  for  my 
position  I  offer  the  following:  There  was  a  State  in  the  Union  that  was  known  to  have 
a  very  imperfect  public-school  system.  It  was  proposed  at  one  time  to  give  this 
State  a  large  amount  of  money  to  help  it  to  do  the  things  that  the  educators  of  the 
country  thought  necessary;  but  this  State,  having  its  deficiencies  pointed  out,  took 
pride  in  doing  the  things  that  other  States  were  doing,  and  as  soon  as  its  real  fighting 
spirit  was  aroused,  as  I  understand,  it  pro\dded  an  educational  system  that  is  equal 
to  that  of  any  State  in  the  I'nion.  I  always  refer  to  my  home  State,  to  my  home 
community,  for  reflexes  of  all  State  and  community  questions.  It  is  my  belief  that 
if  this  central  board  that  is  constituted  by  this  bill  that  is  given  here,  were  to  say  to 
my  State  of  Ohio,  "We  wish  to  proceed  along  certain  lines;  we  have  found  them  well 
to  follow,  and  if  you  do  this  we  will  be  willing  to  grant  you  this  amount  of  money,"' 
Ohio  would  say,  "We  will  adopt  your  plan  and  join  with  you  in  the  general  idea  for 
the  betterment  of  maternity  and  child  welfare  advancement." 

Tie  Chairman.  Suppose  you  had  the  State  of  Maryland,  which  takes  its  inspira- 
tion from  the  authorities  of  Johns  Hopkins  University  in  respect  to  most  medical 
views? 

Gen.  Sawyer.  Yes,  sir. 

The  Chairman.  That  university  has  very  celebrated  men,  and  their  views,  let  us 
say,  prevail  in  the  administration  of  such  matters  in  the  State  of  ^Maryland.  Would 
you  feel  that  if  the  State  and  that  galaxy  of  eminent  authorities  in  that  university, 
to  which  people  go  for  graduate  and  postgraduate  training  from  all  over  the  world, 
should  differ  in  these  matters  that  the  State  of  Maryland  would  be  apt  to  say,  "^\'e 
will  set  aside  the  judgment  of  these  home  experts  and  follow  the  plan  of  a  bureau  in 
Washington,"  for  the  sake  of  getting  money? 


._ 


128  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Gen.  Sawyer.  I  should  feel  that  this  committee,  whoever  was  to  exercise  this  law, 
would  certainly  take  into  conference  the  leading  and  best  minds  in  formulating  their 
plans  for  the  pursuance  of  their  work.  My  own  conduct  of  this  affair  would  be  to 
see  what  other  States  were  really  doing,  and  if  Maryland  had  such  an  excellent  organi- 
zation that  it  should  be  patterned  after  or  should  become  a  part  of  these  regulations, 
then  I  would  certainly  say,  "Let  us  bring  everybody  up  to  the  standard  of  Maryland; 
but  let  us  not  have  the  rest  of  the  United  States  misunderstand  themselves  as  Maryland 
might  possibly  misunderstand  herself. "  It  is  possible  even  for  great  men  and  great 
institutions  to  have  ideas  that  are  really  only  idealistic.  So  there  has  got  to  be  some 
leveling  of  this  whole  matter.  We  should  cut  off  the  peaks  and  fill  up  valleys  and 
come  to  a  common  ground.  That,  I  believe,  is  perfectly  possible  under  a  proper 
central  administration  of  such  affairs. 

The  Chairman.  If  this  bill  should  be  passed — it  is  distinctly  a  lay  bureau  at  the 
present  time — and  if  it  is  wise  to  have  that  bureau  take  into  account  in  its  delibera- 
tions and  exercise  of  its  authority  a  well-defined  medical  department,  would  you 
think  it  well  to  put  in  the  bill  a  provision  to  insure  such  being  done? 

Gen.  Sawyer.  If  there  is  any  doubt  it  should  be  done  now.  Certainly,  there 
would  be  no  danger  in  safeguarding  in  every  way. 

The  Chairman.  Would  you  think  it  a  mse  thing  to  avoid  the  possibility  of  doubt? 

Gen.  Sawyer.  I  have  confidence  myself  in  saying  that  it  hardly  seems  that  should 
be  written  into  the  bill,  but  you  lawmakers  have  a  better  understanding  than  I  have. 

The  Chairman.  You  think  that  it  should  be  safeguarded  if  there  is  any  doubt? 

Gen.  Sawyer.  If  there  is  any  doubt  the  bill  should  be  centralized.  Wherever  there 
is  doubt  that  doubt  should  be  eliminated  before  the  bill  becomes  a  law  so  far  as  it  is 
possible  in  the  judgment  of  those  conducting  the  affair. 

The  Chairman.  General,  if  provision  should  be  made  in  the  bill  for  the  establish 
ment  of  an  advisory  board  to  help  the  regular  members  of  the  bureau  or  department 
would  you  feel  that  there  ought  to  be  at  least  a  predominance  of  medical  men  on  such 
an  advisory  board? 

Gen.  Sawyer.  I  can  hardly  see  the  necessity  of  a  preponderance  of  medical  men 
There  certainly  should  be  a  good,  fair  representation  of  men  of  the  type  that  would 
give  of  their  experience  of  public  health  and  understanding  of  the  professional  side 
of  all  these  questions. 

The  Chairman.  Would  you  feel,  if  there  was  no  authority  appointed  to  cooperate 
with  the  lay  bureau  or  with  any  bureau,  and  an  advisory  committee  were  formed, 
that  a  provision  should  be  made  mandatory  on  the  department  to  select  and  appoint 
such  an  advisory  body? 

Gen.  Sawyer.  I  do  not  quite  luiderstand  that  question,  Mr.  Chairman. 

The  Chairman.  This  bill  authorizes  the  appointment  of  an  advisory  committee 
of  three  in  the  Children's  Bureau.     It  does  not  make  it  mandatory.     Would  you  thinl;  el 
it  wise  not  only  to  give  the  authority,  but  to  make  it  mandatory  on  the  bureau  to  dc 
that? 

Gen.  Sawyer.  An  advisory  committee,  it  seems  to  me,  would  help  to  eliminatf 
any  differences  that  might  come,  outside  of  just  official  relations,  and  so  I  would  saj'bi 
that  that  would  be  a  good  thing  to  have  incorporated,  that  it  should  be  a  matter  o: 
necessity  that  there  should  be  an  advisory  department,  and  as  to  the  constitution  o'. 
the  board  it  would  only  seem  reasonable  that  it  should  have  as  membership  those  wh( 
have  understanding  of  the  various  angles  of  the  subject. 

The  Chairman.  Taking  all  of  these  matters  that  we  have  talked  about  into  consider 
ation,  do  you  see  any  reason  why  the  question  of  passing  this  legislation  either  befortjco 
or  after  the  establishment  of  a  Federal  welfare  department,  would  in  any  way  affeci 
the  proceedings  of  those  who  are  working  out  that  plan? 

Gen.  Sawyer.  As  I  understand  the  matter,  in  conversing  with  those  who  are  inter 
ested  in  this  bill,  and  we  had  reports  from  Mr.  Brown,  of  the  reorganization  committeefc 
it  seems  to  me  that  it  would  be  perfectly  natural  and  would  follow  the  course  that  ] 
outlined  in  my  evidence  here  first,  that  this  would  go  to  the  social  service  divisioi 
of  the  welfare  department. 

The  Chairman.  It  could  be  fitted  in  at  any  time  before  or  after  it  was  established 

Gen.  Sawyer.  I  should  think  so. 

Mr.  Cooper.  General,  you  said  a  few  moments  ago  you  thought  that  this  measur 
was  more  aocialogical  than  medical,  did  you  not? 

Gen.  Sawyer.  Yes,  sir. 

Mr.  Cooper.  You  believe  that  the  social  part  of  a  welfare  and  maternity  case  is  jus 
about  as  important  as  the  medical? 

Gen.  Sawyer.  Do  I  believe? 

Mr.  Cooper.  Yea,  sir. 

Gen.  Sawyer.  I  think  it  is  very  important. 


Pl 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  129 

Mr.  Cooper.  Do  you  know  of  anything  in  tliis  bill  tliat  would  force  any  compulsory 
medical  attention  on  any  citizen  of  this  country  Ly  the  Federal  Government? 
Gen.  Sawyer.  Noj  air;  I  see  nothing  of  that  kind  in  this  hill. 

Mr.  Barfclkv'.  I  gather  from  your  testimony  that  you  are  very  firmly  convinced, 
whether  this  bill  is  enacted  now  or  later,  that  the  Children's  Bureau  as  now  composed 
or  some  sinlilar  bureau  after  any  reorganization  should  have  charge  of  this  work? 
Gen.  Sawykr.  Yes,  sir. 

Mr.  Barklky.  After  any  possible  reorganization  is  made,  if  the  Children's  Bureau 
is  to  remain  in  effect  either  by  that  name  or  some  other  name,  it  should  continue  to 
have  charge  of  this  work? 
Gen.  Sawyer.  It  naturally  would. 

Mr.  Barkley.  Then,  the  arrangement  provides  for  the  Children's  Bureau  as  such 
to  be  transferred  to  the  new  department? 
Gen.  Sawyer.  Yes,  sir. 

Mr.  Barkley'.  Is  it  called  the  Children's  Bureau  in  that  arrangement? 
Gen.  Sawyer.  The  Kenyon-Fess  bill  transfers  the  Children's  Bureau  to  the  Depart- 
ment of  Public  Welfare. 

Mr.  Barkley.  So  it  would  transfer  with  its  personnel  and  its  authority  all  the 
functions  that  have  been  conferred  upon  it  by  any  act,  including  this  act? 
Gen.  Sawyer.  That  is  my  understanding. 

Mr.  Barkley'.  So  there  would  be  no  hiatus  or  interregnum,  so  to  speak,  between 
ithe  enactment  of  this  law  and  any  reorganization? 
(j    Gen.  Sawyer.  I  think  not,  sir. 

!i    Mr.  Barkley'.  Going  back  to  the  question  of  State  regulations,  is  it  not  a  fact  that 
l^he  medical  profession  and  the  socialogical  workers  generally  all  over  the  country, 
.regardless  of  where  they  live,  have  very  general  ideas  as  to  what  is  needed  with  refer- 
Jjnce  to  the  care  of  children  and  the  prenatal  care  of  mothers? 
i|    Gen.  Sawyer.  Yes,  sir. 

j    Mr.  Barkley'.  There  is  not  any  great  conflict  between  people  who  are  interested 
,|.n  this  subject  in  the  various  States  as  to  what  should  be  done? 
i     Gen.  Sawyer.  Not  to  my  knowledge.     I  can  see  no  reason  why  there  should  be. 
e     Mr.  Barkley.  All  of  the  work  now  is  being  done  practically  by  the  medical  pro- 
fession and  is  being  done  under  the  various  boards  of  health  of  the  States? 
Gen.  Sawyer.  Yes,  sir. 

Mr.  Barkeley.  They  have  worked  out  a  sort  of  harmonious  plan? 
Gen.  Sawyer.  So  far  as  I  know.     I  am  not  posted  on  that  thoroughly  enough  to  say 
positively,  but  I  should  say  that  they  have  or  they  would  not  continue  it. 
I    Mr.  Barkley'.  There  is  not  likely  to  be  any  great  conflict  between  whatever  super- 
elasory  plan  might  be  adopted  by  the  Children's  Bureau  so  long  as  it  is  sufficiently 
iiilastic  to  apply  to  the  conditions  existing  in  each  State? 

o|  Gen.  Sawyer.  I  take  it  the  people  here  are  going  to  take  into  conference  the  peo- 
ble  in  the  States  and  certainly  adopt  the  best.  I  would  be  very  much  opposed  to 
ejiny  measure  that  takes  away  personal  incentive  or  takes  away  competitive  possi- 
y!)ility.  Whenever  we  do  that  in  this  country  we  have  restricted  ourselves  in  a  way 
ii  hat  would  be  dangerous,  but  I  can  see  none  of  that  featiire  in  this  arrangement, 
riiis  is  really  a  matter  of  understanding  between  these  sections. 

Mr.  Barkley.  In  other  words,  it  is  not  your  idea  that  those  who  will  be  in  charge 
if  this  work  in  Washington  are  going  to  put  it  in  a  strait-jacket  by  taking  away  any 
ort  of  leeway  or  any  breadth  of  action  that  might  be  necessary  dependent  on  various 
;onditions  existing  in  different  paits  of  the  country? 

Gen.  Sawyer.  I  do  not  think  there  would  be  any  danger  of  that.     My  contact 
idth  Miss  Lathrop  has  been  such  as  to  impress  me  with  the  feeling  that  she  is  a  broad- 
oinded  woman  working  for  just  what  we  are  all  working  for  in  this  bill,  and  if  she  is 
,  sample  of  those  who  will  help  to  execute  these  matters  I  feel  quite  safe. 
Mr.  Barkley'.  I  think  that  is  all.  General. 

Mr.  Graham.  Of  course,  you  understand,  Dr.  Sawyer,  that  we  are  not  dealing  with 
liss  Lathrop.     The  power  will  be  given  to  the  Children's  Bureau,  which  is  an  im- 
lersonal  thing  and  which  goes  on  forever. 
Gen.  Sawyer.  Yes,  sir. 
ie|  Mr.  Graham.  Miss  Lathrop  may  die.     She  is  for  the  time  being  occupying  that 
osition.     The  only  proper  way  in  arriving  at  our  conclusion  is  to  consider  what  is 
tght  or  wrong  with  this  matter. 
Gen.  Sawyer.  Individuals  must  be  forgotten;  only  principles  should  live. 
Mr.  Graham.  Let  me  see  if  I  get  your  idea.     You  conclude  that  this  is  purely  a 
Jciological  question? 
Gen.  Sawy'er.  I  do. 

74654^-21 9 


J.. 


130  PUBLIC  PROTECTION   OF  MATERITITY  AND  INFANCY. 

Mr.  Graham.  And  if  it  trenches  upon  the  medical  side  in  any  way  that  function 
ought  to  be  at  once  transferred  to  the  medical  department,  namely,  the  Public  Health 
Service? 

Gen.  Sawyer.  Absolutely  so. 

Mr.  Graham.  Then,  the  plan  that  you  and  others  have  in  mind  in  this  bill  is  simply 
one  of  instruction,  helpful  instruction,  to  be  given  to  the  people? 

Gen.  Sawyer.  Yes,  sir. 

Mr.  Graham.  Let  ua  see  how  far  the  Federal  Government  can  properly  go  into 
that.  People  in  crowded  industrial  districts  frequently  live  in  an  insanitary  way. 
They  do  not  exercise  the  proper  precaution  as  to  sanitation  and  hygiene,  they  do  not 
have  proper  ventilation,  they  do  not  have  proper  and  healthful  exercise — that  fre- 
quently happens — all  of  which  might  be  obviated  by  halpful  instruction  in  social 
centers,  where  they  would  be  taught  how  to  liv3,  and  in  that  way  tuberculosis  might 
be  lessened  and  many  other  conditions  might  be  alleviated  somewhat.  Do  you 
think  it  is  a  good  thing  for  the  Federal  Government  to  start  into  the  work  of  showing 
the  people  how  to  live,  how  to  practice  sanitation  properly,  hygiene,  and  those  things, 
by  legislation  something  like  this? 

Gen.  Sawyer.  I  believe  the  Government  that  serves  its  citizens  best  that  provides 
ways  and  means  of  understanding  for  those  people  whereby  they  will  expose  them- 
selves to  the  least  liability  in  whatever  engagement  in  Jife  they  may  participate, 
whether  it  is  in  giving  birth  to  children  or  whether  it  has  to  do  with  any  other  home 
relations.  Sanitation  belongs  to  the  Public  Health  Service.  _  It  is  the  business  of  the 
Public  Health  Ser\'ice,  as  I  understand  it,  to  fix  the  regulations  by  which  homes  are 
kept  clean,  and  it  fixes  policies  of  sewage,  of  ventilation,  and  of  cleanliness  generally. 
All  of  those  things  belong  to  the  Public  Health  Service,  while  on  the  other  hand  the 
social  side  of  this  subject  must  get  down  to  the  homes  through  other  channels  of  infor- 
mation and  personal  contact.  Public  Health  Service  may  understand  the  social 
needs  well  and  the  Public  Health  Service  should  be- in  a  position  to  assist  in  the 
enforcement  of  the  sociological  requirements,  but  the  Public  Health  Service  has  not 
the  machinery  sufiicient  to  carry  all  of  these  matters,  and  here  comes  the  social  ser- 
vice helper  to  assist  in  the  fullest  benefits  to  come  from  such  measures. 

The  social  workers  go  into  the  homes;  showing  these  mothers,  they  take  the  subject 
up  from  the  socialogical  side  with  families,  and  my  feeling  is  that  such  is  the  best 
public  instruction  that  you  could  possibly  be  given.  I;t  is  not  sufficient  to  bi;ing  about 
the  best  results,  to  have  information  given  out  by  those  who  do  not  know,  but  rather 
by  those  who  are  posted  and  educated  in  the  advice  they  are  trying  to  impart,  by  the 
brotherly  spirit  which  we  are  trying  to  develop  in  these  United  States  of  America 
to-day;  it  is  perfectly  possible  to  make  the  people  see  the  importance  of  the  law. 

Mr.  Graham.  Is  there  as  much  reason,  in  your  mind,  for  Government  encourage- 
ment by  financial  aid  to  the  practice  of  proper  rules  of  living  and  hygiene  as  there  is 
for  this  sort  of  legislation,  or  maternity  legislation? 

Gen.  Sawyer.  I  think  that  in  order  to  make  either  of  them  effectual,  or  to  bring 
about  the  results  that  all  of  us  have  in  mind,  it  is  quite  necessary  that  those  things 
should  go  hand  in  hand. 

Mr.  Graham.  Let  us  go  a  step  further:  I  suppose  you  will  agree  with  me  that  there 
is  no  grea,ter  evil  in  thp  country  than  syphilis,  or  that  there  is  a  no  more  widespread 
and  prevalent  ill  of  the  human  race  or  anything  that  curses  the  human  race  more  than 
that  disease.  As  I  am  informed,  that  ailment  causes  a  good  deal  of  infant  mortality 
and  sickness,  including  the  sickness  of  mothers,  and  a  great  deal  of  operative  work. 
Now,  what  would  you  say  to  the  proposition  of  the  Government  establishing  a  service 
something  like  the  one  proposed  here,  going  out  into  the  various  States  along  the  lines 
proposed  in  this  bill,  so  that  by  that  means  instruction  might  be  given  to  the  people 
with  the  idea  in  mind  of  a  possible  alleviation  and  prevention  of  venereal  diseases  in 
this  country? 

Gen.  Sawyer.  It  is  perfectly  reasonable  to  incorporate  that  instruction  in  all  of 
his'advice  that  you  are  giving  to  the  people,  and  I  think  it  is  the  right  of  the  Govern- 
ment to  go  that  far;  but  we  have  no  right  to  assume  unto  ourselves  through  any  social 
service  relations  responsibility  for  the  treatment  of  the  individual. 

Mr.  Graham.  I  am  simply  citing  this  example  here  to  show  you  what  is  in  my 
mind,  that  is,  when  you  want  to  embark  upon  the  line  of  sociology  by  the  Federal 
Government,  the  field  is  boundless,  and,  so  far  as  I  am  concerned,  I  can  not  see  the 
end.     All  of  those  matters  are  proper  matters  to  be  done,  but  the  question  in  my  mind  % 
is  whether  the  Federal  Government  ought  to  now  undertake  that  job. 

Gen.  Sawyer.  That,  of  course,  is  a  matter  that  must  be  left  to  the  consideration  of 
you  people,  who  are  better  qualified  than  "anybody  else  to  say.  You  know,  whether 
or  not,  thisisthe^time.  You  know  that.  We  are  all  agreed  that  the  principle  is  right. 
Now,  if  it  is  possible  for  you  to  carry  out  this  principle,  then  the  time  is  ripe,  but  you[ai, 
must  judge  of  that.     I  would  not  attempt  to  advise  you  in  that  regard. 


PUBLIC   PROTECTION   OE   MATERNITY   AND   INFANCY.  131 

Mr.  CiRAiiAM.  In  jud,<;in<!;  of  that  need,  and  looking'  forward  and  seeing  the  field 
before  us,  and  the  broad  extent  of  it,  we  must  Tialiirally  take  into  eonsideration  the 
financial  condition  of  our  country. 

Gen.  Sawyer.  A])solutely  so.      I  agree  with  you  there. 

Mr.  Graham.  You  will  n'j^ree  with  me  that  at  this  time  there  is  every  need  for  the 
most  rigid  economy? 

Gen.  Sawyku.  Absolutely  so. 

Mr.  Newton.  Is  it  your  understanding  that  the  Government  is  now  conducting 
some  considerable  work  against  the  spread  o.f  venereal  disease  thiough  the  Inter- 
Departimental  Social  Hygiene  Board  appropriation?  It  seems  to  me  that  it  involved 
an  appropriation  of  several  hundred  thousand  dollars. 

Mr.  (jkaiiam  .   [  am  inclined  to  think  there  is  some  of  that  work  going  on. 

Mr.  Johnson.  It  was  not  included  in  the  last  appropriation  act. 

Mr.  Graham.  I  do  not  think  there  was  anything  provided  in  the  last  bill,  but  we 
did  a  great  deal  of  that  work  during  the  war. 

Mr.  IN'ewton.  I  think  if  you  will  examine  the  act,  you  will  Mnd  that  there  was  quite 
a  substantial  appro])riation  made  for  that  purpose. 

Mr.  Johnson.  I  do  not  think  you  will  find  it  in  the  last  appropriation  act. 

Gen.  Sawyer.  If  I  may  be  permitted  to  answer  your  question,  the  appropriation 
for  this  year  for  the  Inter-Departmental  Social  Hygiene  Board  was  1225,000. 

Mr.  Johnson.  They  put  it  on  in  the  Senate. 

Gen.  Sawyer.  They  are  operating  under  that. 

Mr.  Graham.  That  refreshes  my  memory,  and  let  me  ask  you,  Doctor,  how  was 
that  to  be  spent? 

Gen.  Sawyer.  I  tliink  that  is  spent  through  a  commission  or  bureau  or  committee, 
and  the  general  directors  of  that  affair  are  the  Surgeon  General  of  the  Bublic  Health 
Service,  the  Surgeon  General  of  the  Army,  the  Surgeon  General  of  the  Navy,  and 
perhaps,  the  Secretary  of  the  Treasury,  but  I  am  not  sure  about  that. 

Mr.  Graham.  But  you  know  of  no  plan  by  which  it  is  partitioned  out  to  the  various 
States  to  be  spent  by  the  States? 

Gen.  Sawyer.  No,  sir.  I  really  am  not  familiar  with  the  way  of  carrying  it  out, 
but  this  $225,000  is  spent  by  the  Government. 

Mr.  Newton.  Is  it  not  spent  in  connection  with  or  matched  by  funds  of  the  States? 

Gen.  S.^wY'ER.  I  think  not,  but  I  am  not  sure  about  that. 

Mr.  Newton.  I  only  have  an  impression  about  it.  I  received  a  communication 
from  the  State  health  directors  of  Minnesota,  which  led  me  to  believe  that  it  ia 
matched  by  similar  funds  of  the  States. 

Gen.  Sawyer.  I  can  not  answer  that. 

Mr.  Barkley'.  Doctor,  I  would  like  to  get  your  views  on  this  matter:  You  stated 
to  Mr.  Graham  in  response  to  a  question  that  there  was  a  most  urgent  need  for  tbia 
work,  if  it  is  the  policy  of  the  Government  to  enter  into  it? 

Gen.  Sawyer.  Yes,  sir. 

Mr.  BARKLEY^  About  that  all  of  us  are  agreed. 

Gen.  Sawyer.  Yes,  sir. 

Mr.  Baekley.  From  your  survey,  brief  as  it  may  have  been,  with  reference  to 
the  various  acti\'ities  of  the  Government  and  the  possibility  of  reducing  expenditurefi 
in  some  places  where  they  are  too  large,  are  you  willing  to  say  that  the  need  for 
economy  at  this  particular  time  is  so  urgent  as  to  counterbalance  the  need  for  iJia 
legislation  that  we  are  now  considering? 

Gen.  Sawyer.  That  is  a  question  that  I  would  like  more  time  for  consideration 
before  answering.  Really,  I  have  not  gone  into  Just  exactly  what  this  means  j>» 
the  matter  of  expense.  I  have  looked  at  it  entirely  from  the  standpoint  of  what  *v 
would  do  for  the  people. 

Mr.  Barkley.  That  being  true,  is  it  always  best  to  weigh  dollars  a  ain>st  the 
welfare  of  humanity  in  matters  of  legislation  of  this  sort? 

Gen.  Sawy'er.  I  would  hardly  say  "against"  but  urith  it. 

Mr.  Johnson.  General,  unfortunately  I  was  not  present  when  you  began  your 
statement.     Do  you  speak  for  the  President? 

G«n.  Sawyer.  No,  sir;  that  is  a  responsibility  I  never  assiune.  I  appear  here 
for  Dr.  Sawyer. 

The  Chairman.  He  appears  upon  the  in\dtation  of  the  chairman  to  testify  as  to 
how  this  would  fit  in  with,  the  general  welfare  department. 

Mr.  Johnson.  I  expect  to  readGen.  Sawyer's  testimony.  I  did  not  hear  it,  and  I 
wanted  to  know  for  whom  he  appears. 

i\fr.  Hawes.  I  am  in  perfect  accord  with  you  in  your  observations  about  Miss 
Lathrop,  and  also  Avith  your  opinion  that  the  law  should  be  written  around  a  principle 
ind  not  around  a  person.     Now,  the  difficulty  with  this  law,  in  my  opinion,  is  that  it 


132  PUBLIC  PKOTECTIOIsr   OP   MATERNITY  AND  INFANCY. 

does  not  define  the  duties  of  this  bureau  either  nationally  or  in  relation  to  the  State, 
but  in  section  8  it  delegates  to  the  bureau,  when  formed,  the  A^Titing  of  the  regulations 
governing  it  both  nationally  and  as  to  the  conditions  under  which  the  State  will 
either  accept  aid  or  refuse  it.  From  your  administrative  experience,  do  you  not 
think  that  that  ought  to  be  a  matter  of  law,  or  that  the  regulations  should  be'written 
into  the  law  itself? 

Gen.  Sawyer.  I  have  made  that  same  observation,  and  it  is  my  contention  that 
regulations  written  by  individuals  who  are  authorized  by  bills  to  make  regulations, 
establishes  a  dangerous  precedent  and  should  not  prevail.  I  think  such  authority 
brings  our  greatest  troubles,  because  regulations  are  often  interpreted  to  be  law. 
For  instance,  in  affairs  pertaining  to  the  obtaining  of  alcohol  by  physicians.  It  is  not 
the  law  but  the  exhaustive  regulations  which  cause  great  trouble.  I  should  say  there 
is  no  trouble  from  the  statute,  but  through  regulations  that  have  been  written  by  some 
one  incapable  of  a  proper  understanding  of  the  necessities  of  the  case. 

Mr.  Hawes.  Which  may  change  each  30  days? 

Gen.  Sawyer.  Yes;  even  oftener.  We  have  recently  experienced  this  in  the 
matter  of  the  administration  of  the  veterans'  compensation.  We  have  found  the  law 
meaning  one  thing  and  while  on  the  other  hand  the  department  chief  places  regulations 
which  put  an  entirely  different  interpretation  upon  the  whole  subject.  In  this  con- 
nection I  would  call  attention  to  regulation  No.  57,  promulgated  by  the  former  Director 
of  the  Bureau  of  War  Risk  Insurance.  This  regulation  has  worked  great  injury  to  the 
war  veteran  and  has  brought  much  extravagant  expenditure  to  the  Government. 

Mr.  Hawes.  Until  -within  the  last  10  years,  the  laws  of  the  United  States  were 
written  clearly  and  understandably  in  the  statutes,  and  that  statement  applies  both 
to  the  laws  of  the  States  and  of  the  United  States;  but  there  has  been  a  departure 
recently  by  which  boards,  bureaus,  and  commissions  make  the  laws  that  Congress  does 
not  itself  define.  I  understand,  you  think  that  they  should  be  written  clearly  into 
the  law. 

Gen.  Sawyer.  The  power  to  make  regulations  should  not  be  given  the  unlimited 
privilege  which  they  are  given  in  many  of  our  l9,ws.  I  am  sure  that  a  far  better  plan 
is  to  write  into  the  law  very  specifically  the  functions  to  be  performed. 

Mr.  Hawes.  I  am  in  accord  with  you  on  this  whole  matter. 

Mr.  HocH.  General,  I  would  like  to  get  your  statement  upon  a  fundamental  proposi- 
tion touched  upon  a  moment  ago.  One  of  the  witnesses,  a  doctor,  who  testified 
before  the  committee  on  yesterday,  sought  to  lay  down  this  proposition,  that  it  was 
the  business  of  the  State,  or  of  the  Government,  to  interfere  in  health  matters  only 
with  reference  to  those  matters  which  might  be  held  to  affect  the  community,  particu- 
larly contagious  diseases,  but  that  when  it  came  to  those  diseases  that  are  purely 
individual  and  which  do  not  involve  directly  any  menace  to  the  health  of  the  com- 
munity, those  matters  should  be  left  entirely  to  the  medical  profession.  Have  you 
a  clear  statement  to  make  in  regard  to  that,  or  can  you  make  a  statement  as  to  just 
how  far  you  think  it  is  the  business  of  the  Government  or  the  State  to  go  with  refer- 
ence to  health  matters? 

Gen.  Sawyer.  Whenever  the  State  says  that  you  shall  employ  a  certain  doctor, 
or  a  certain  class  of  doctors  that  are  licensed  by  the  State  laws,  then  you  have  gone 
too  far.  Then  you  take'away  the  right  of  citizenship.  What  I  think  you  could  safely 
do  through  the  Government  is  this:  You  could  accumulate  evidence,  information, 
facts,  and  examples,  showing  the  best  course  of  procedure  in  the  handling  of  com- 
munity subjects,  but  when  you  go  so  far  as  to  touch  individual  subjects,  then,  in  my 
opinion,  you  have  gone  too  far.  You  should  not  do  that  except  as  they  are  a  menace 
to  the  public.     Do  I  answer  your  question?     I  mean  to. 

Mr.  HocH.  Following  up  that  proposition,  to  illustrate:  It  is  the  business  of  the 
State  to  furnish  information  and  adopt  regulations  with  reference  to  smallpox,  because 
it  is  a  communicable  or  contagious  disease.  Now,  is  it  the  business  of  the  State  to 
furnish  information  and  suggestions  with  reference  to  heart  trouble? 

Gen.  Sawyer.  I  think  that  it  is  only  the  business  of  the  State  to  tell  the  people 
how  they  may  prevent  smallpox.  It  is  only  the  business  of  the  State  to  try  to  develop 
the  best  physical  system  that  can  be  instituted  in  any  way  to  help  the  people  to  pre- 
vent heart  trouble;  but  certainly  there  is  nothing  in  the  Government  that  can  say 
to  you  or  to  any  of  this  audience  what  you  shall  do  for  so-called  heart  trouble,  because 
heart  trouble  in  itself  is  a  term  that  does  not  mean  anything,  and  that  would  be  a 
dangerous  precedent  to  establish. 

Mr.  HocH.  For  the  purposes  of  our  illustration,  I  am  not  now  speaking  of  treat- 
ments, but  I  am  speaking  of  the  dissemination  of  information  with  reference  to  those 
physical  ailments  which  are  purely  individual,  and  which  do  not  involve  a  menace 
to  the  community.  Do  you  think  that  it  is  the  business  of  the  Government  to  gather 
and  to  disseminate,  either  by  bulletins,  by  agents,  or  in  any  other  way,  information 
with  reference  to  those  ailments  that  are  purely  individual? 


PUBLIC   PROTECTION   OP   MATERNITY   AND   INFANCY.  133 

Gen.  Sawyef!.  I  think  it  is  only  the  business  of  the  (iovernment  to  do  those  things 
that  will  protect  the  people  from  the  danger  or  lialjility  of  contact  with  disease,  and 
to  prevent  the  spreading  of  disease. 

Mr.  HocH.  I  am  asking  that  question  because  it  seems  to  me  that  fundamentally 
that  is  the  problem  involved  in  this  bill.  For  instance,  there  is  important  informa- 
tion that  can  be  given  wdth  reference  to  prenatal  care. 

Gen.  Sawyer.  Yes,  sir. 

Mr.  HocH.  In  what  sense  can  information  with  reference  to  prenatal  care  be  said 
to  be  a  community  matter  in  the  sense  you  have  outlined,  and,  therefore,  a  proper 
function  of  the  Government? 

Gen.  Sawyrr.  In  this  way:  We  know  that  the  mortalily  rate  of  children,  the  dis- 
eases and  afllictions  of  children,  and  the  disorders  of  children  are  due  to  conditions 
which  ma\-  well  be  anticipated  by  understanding  and  prevented  by  proper  informa- 
tion. 1  think  we  have  the  best  evidence  of  that  in  fopbthalmia  neonatorum)  the  dis- 
eased condition  of  the  eye  that  affects  so  many  children  at  childbirth.  Anything 
that  will  help  the  people  to  a  better  understanding  of  the  precautionary  measures 
that  they  should  take  is  certainly  a  very  good  thing. 

Mr.  IIocH.  Regardless  of  that  fact,  you  think  that  our  limit  is  when  the  disease  or 
contagion  involves  a  direct  menace  to  the  community? 

Gen.  Sawyer.  I  think  it  is  our  duty  to  help  anybody  and  everybody  we  can  Ijy 
information  to  prevent  any  disorder,  whether  it  be  an  individual  or  a  community. 

Mr.  IIocH.  When  you  say  "'our  duty,"  do  you  mean  the  duty  of  the  State? 

Gen.  Sawyer.  If  we  are  going  into  the  sociological  question  at  all,  then  it  is  our 
duty  to  be  as  liroadgauged  as  possible. 

Mr.  IIocH.  Then,  as  a  matter  of  fact,  there  is  no  very  clear  distinction  in  your 
mind  l^etween  the  function  of  the  Government  and  the  function  of  private  agencies 
in  these  matters,  because  any  of  those  phvsical  ailments,  however  personal  or  indi- 
vidual they  may  be,  involve  of  course  in  the  long  run  damage  to  the  community  by 
injuring  any  unit  of  it,  and  therefore  you  would  say,  would  you,  that  there  is  no  limit 
to  the  proper  domain  of  the  Government  in  health  matters? 

Gen.  Sawyer.  Let  me  tell  you  what  I  think  the  Government  should  do,  and  what 
I  think  is  really  necessary.  Our  greatest  asset  is  our  health.  Everything  that  the 
Government,  State  and  National,  can  do  to  improve  our  people  physically  and  thereby 
mentally  is  a  splendid  thing  for  the  Government  to  do.  Therefore,  in  the  matter  of 
information  and  examples  to  be  given  out,  let  the  C^entral  Government  offer  some- 
thing really  worth  while,  something  the  Government  can  indorse,  and  not  only  recom- 
mend, but  stand  behind.  The  great  trouble  with  so  much  of  our  social  service  work 
at  present  is  that  one  individual  becomes  inspired  with  the  thought  that  he  must  do 
this  thing,  and  he  creates  around  himself  an  atmosphere  that  helps  him  on  in  that 
thing. 

Then  here  comes  another  one  who  has  the  idea  that  God  Almighty  intended  that 
he  should  do  some  special  work  in  the  regulation  of  the  a'i'airs  of  life,  and  an  organiza- 
tion is  created  around  that  proposition,  therefore,  we  find  many  duplications;  that 
in  the  city  of  Washington  we  have  151  uplifting  organizations.  Now,  what  can  the 
Government  do  to  counteract  such  overlapping?  The  Government  can  say  what  of 
those  things  arp  worth  while,  as  shown  by  experience,  observation,  facts,  and  statis- 
tics. \\Tien  the  Government  can  say  to  its  people  "These  are  worth  doing,  and  this 
is  the  plan  by  which  they  should  be  done. "  ']  hen  all  who  are  subscribing  to  funds 
for  such  enterprises  will  gladly  say,  "Fortunately,  the  Government  has  shown  the 
way  by  which  we  can  go  ahead  upon  a  systematized  plan,  getting  at  the  end 
results — something  worth  while."  Frankly,  in  all  of  the  study  that  I  have  given  to 
this  matter  of  welfare  in  the  city  of  Washington  and  before  I  came  here,  I  have  found 
more  difficulty  in  the  social-ser\dce  relations  than  in  all  of  the  rest  of  the  subject. 

Mr.  HocH.  Do  you  think  it  would  be  a  proper  thing  for  the  Government,  or  a  proper 
function  of  a  bui'eau  of  the  Government,  to  prepare  bulletins  with  reference  to  health 
exercises,  physical  exercises,  or  with  reference  to  diet  and  matters  of  that  sort,  and 
disseminate  that  information  systematically  to  the  people,  and,  perhaps,  send  agents 
out  over  the  country  to  give  instructions  in  the  proper  exercise  to  be  taken  and  in 
proper  diet  regulations?  I  am  approaching  this  from  the  governmental  standpoint, 
and  I  ask  if  that  is  a  proper  function  of  the  Government  so  that  we  may  know  where 
we  are  leading  to  Avhen  we  are  entering  a  new  field.  Do  you  think  that  would  be  a 
legitimate  function  of  the  Government? 

Gen.  Sawy'er.  In  the  welfare  department  that  we  have  in  mind,  we  would  have  a 
publicity  department.  Y^our  illustrations  are  such  as  to  bring  a  question  to  my  mind 
as  to  the  direction  we  should  travel,  or  how  far  we  should  go.  For  instance,  we  know 
so  little  about  dietetics  in  the  United  States  or,  for  that  matter,  anywhere  in  the 
world,  that  it  seems  to  me  to  be  impossible  for  the  Government  to  teach  people  how 
and  what  to  eat,  but  I  think  it  would  be  well  for  us  to  take  up  in  an  educational 


134  PUBLIC   PKOTECTION   OF   MATERISTITY  AND   INFANCY, 

system  a  policy  that  would  be  sound  and  usable.  Such  a  policy  would  well  apply, 
for  instance,-  in  the  Department  of  Vocational  Training,  in  physical  development 
and  recreational  engagement.  I'he  Government  could  well  serve  in  that  capacity 
in  all  these  matters. 

Mr.  Newton.  'Pi.eferring  to  the  colloquy  which  occurred  a  few  minutes  ago  in 
reference  to  the  functions  of  the  Interdepartmental  Social  Hygiene  Board,  I  would 
like  to  have  inserted  into  the  record  the  Interdepartmental  Social  Hygiene  Board  act. 

(The  act  referred  to  follows;) 

"Interdepartmental  Social  Hygiene  Board:  That  there  is  hereby  created  a  board 
to  be  known  as  the  Interdepartmental  Social  Hygiene  Board,  to  consist  of  the  Sec- 
retary of  War,  the  Secretary  of  the  Navy,  and  the  Secretary  of  the  Treasury  as  ex  ofBcio 
members,  and  of  the  Surgeon  General  of  the  Army,  the  Surgeon  General  of  the  Navy, 
and  the  Surgeon  General  of  the  Public  Health  Service,  or  of  representatives  designated 
by  the  Secretary  of  War,  the  Secretary  of  the  Navy,  and  the  Secretary  of  the  Treasury, 
respectively.  The  duties  of  the  board  shall  be :  (1)  To  recommend  rales  and  regula- 
tions for  the  expenditure  of  moneys  allotted  to  the  States  under  section  5  of  this 
chapter;  (2)  to  select  the  institutions  and  organizations  and  fix  allotments  to  each 
institution  under  said  section  5 ;  (3)  to  recommend  to  the  Secretary  of  the  Treasury, 
the  Secretary  of  War,  and  the  Secretary  of  the  Navy  such  general  measures  as  will 
promote  correlation  and  efficiency  in  carrying  out  the  purposes  of  this  chapter  by 
their  respective  departments;  and  (4)  to  direct  the  expenditure  of  the  sum  of  $100,000 
referred  to  in  the  last  paragraph  of  section  7  of  this  chapter.  The  board  shall  meet 
at  least  quarterly,  and  shall  elect  annually  one  of  its  members  as  chairman,  and  shall 
adopt  rules  and  regulations  for  the  conduct  of  its  business. 

"Sec.  2.  That  the  Secretary  of  War  and  the  Secretary  of  the  Navy  are  hereby 
authorized  and  directed  to  adopt  measures  for  the  purpose  of  assisting  the  various 
States  in  caring  for  civilian  persons  whose  detention,  isolation,  quarantine,  or  com- 
mitment to  institutions  may  be  found  necessary  for  the  protection  of  the  military  and 
naval  forces  of  the  United  States  against  venereal  diseases. 

"Sec.  3.  That  there  is  hereby  established  in  the  Bureau  of  the  Public  Health 
Service  a  Di^dsion  of  A^enereal  Diseases,  to  be  imder  the  charge  of  a  commissioned 
medical  officer  of  the  United  States  Public  Health  Service  detailed  by  the  Surgeon 
General  of  the  Public  Health  Service,  which  officer  while  thus  serving  shall  be  an 
Assistant  Surgeon  General  of  the  Public  Health  Ser%ice.  subject  to  the  pro\dsions  of 
law  applicable  to  assistant  surgeons  general  in  charge  of  administrative  divisions  in 
the  District  of  Columbia  of  the  Bureau  of  the  Public  Health  Ser\dce.  There  shall  be 
in  such  division  such  assistants,  clerks,  investigators,  and  other  employees  as  may  be 
necessary  for  the  performance  of  its  duties  and  as  may  be  provdded  for  by  law. 

"Sec  4.  That  the  duties  of  the  Di\'lsion  of  Venereal  Diseases  shall  be  in  accordance 
with  rules  and  regulations  prescribed  by  the  Secretary  of  the  Treasury,  (1)  to  study 
and  investigate  the  cause,  treatment,  and  prevention  of  venereal  diseases;  (2)  to 
cooperate  with  State  boards  of  departments  of  health  for  the  prevention  and  control 
of  such  diseases  Avithin  the  States;  and  (3)  to  control  and  prevent  the  spread  of  these 
diseases  in  interstate  traffic:  Provided,  That  nothing  in  this  chapter  shall  be  construed 
as  limiting  the  functions  and  acti\'lties  of  other  departments  or  bureaus  in  the  pre- 
vention, control,  and  treatment  of  venereal  diseases  and  in  the  expenditure  of  moneys 
therefor. 

"Sec.  5.  That  there  is  hereby  appropriated,  out  of  any  money  in  the  Treasury  not 
otherwise  appropriated,  the  sum  of  $1,000,000,  to  be  expended  under  the  joint  direc- 
tion of  the  Secretary  of  War  and  the  Secretary  of  the  Navy  to  carry  out  the  provisions 
of  section  2  of  this  chapter:  Provided,  That  the  appropriation  herein  made  shall  not 
be  deemed  exclusive,  but  shall  be  in  addition  to  other  appropriations  of  a  more  general 
character  Avhich  are  applicable  to  the  same  or  similar  purposes. 

"Sec.  6.  That  there  is  hereby  appropriated,  out  of  any  moneys  in  the  Treasury 
not  otherwise  appropriated,  the  sum  of  $1,400,000  annually  for  two  fiscal  years,  begin- 
ning with  the'fiscal  year  commencing  July  1,  1918,  to  be  apportioned  as  folloAvs: 
The  sum  of  $1,000,000,  which  shall  be  paid  to  the  States  for  the  use  of  their  respective 
boards  or  departments  of  health  in  the  prevention,  control,  and  treatment  of  venereal 
diseases;  this  sum  to  be  allotted  to  each  State,  in  accordance  with  the  rules,  and  regu- 
lations prescribed  by  the  Secretary  of  the  Treasury,  in  the  proportion  which  its  popu- 
lation bears  to  the  population  of  "the  continental  United  States,  exclusive  of  Alaska 
and  the  Canal  Zone,  according  to  the  last  preceding  United  States  census,  and  such 
allotment  to  be  so  conditioned  that  for  each  dollar  paid  to  any  State  the  State  shall 
specificalljr  appropriate  or  otherwise  set  aside  an  equal  amount  for  the  prevention, 
control,  and  treatment  of  venereal  diseases,  except  for  the  fiscal  year  ending  Jime  30, 
1919,  for  which  the  allotment  of  money  is  not  conditioned  upon  the  appropriation  or 
setting  aside  of  money  by  the  State,  provided  that  any  State  may  obtain  any  part 
of  its  allotment  for  any  fiscal  year  subsequent  to  June  30,.  1919,  by  specifically  appro- 


J 


PUBLIC  PROTECTION   OF   MATERNITY  AND   INFANCY.  135 

linfr  or  otherwise  setting  aside  an  amount  equal  to  such  part  of  its  allotment  for 

.  provontion,  control,  and  treatmont  of  venereal  disfasea:  the  sum  of  $100. ()()(). 
wliifli  shall  he  ])oid  to  such  universities.  c()ll('<,'rs.  or  other  siiital)Ic  institntioiis.  as  in 
the  jiidt^'mcnt  of  the  Interdepartmental  Social  lly^iene  Board  are  (|nali(ied  for  scien- 
tific research,  for  the  i)itri)ose  of  distw crin^.  in  accordance  with  rnles  and  rejjulations 
prescribed  by  the  Interdepartmental  Social  IfvLricno  iioard.  more  effttctive  medical 
measures  in  the  prevention  and  treatment  of  venereal  diseases;  th(!  .sum  of  .$:{00.00(), 
which  shall  be  ])aid  to  s.ich  universities.  colloLres,  or  other  suitai)le  institutions  or 
organizations,  as  in  the  jud.ijment  of  the  Interde])aitnu'ntal  Social  Ifytriene  lioard  are 
qualified  for  scientific  research,  for  the  Treasury  not  otherwise  ap])roi)rialed.  the  sum 
of  $300,000  for  measures  in  the  ])reA-eiition  of  venereal  diseases,  and  for  the  pur|>o6e 
of  sociologi(;al  and  psychological  research  related  thereto. 

''Sec.  7.  That  there  is  hereby  a])})roi)ria1ed.  oi't  of  any  money  in  the  Treasury  not 
otherwise  ai)in-opriated.  the  sum  of  .S;500.0Q0  for  the  fiscal  year  ending  June  30,  1019, 
tobe  a])])ortioned  asfollows;  The  sum  of  $200,000  to  defray  the  expenses  of  the  estab- 
lishment and  maintenance  of  the  Division  of  \'enereal  Disea^^es  in  the  Bureau  of  the 
Public  Health  Ser^•ice,  and  the  sum  of  SIOO.OOO  to  be  i:sed  under  the  direction  of  the 
Interde]nirtmental  Social  Hygiene  Board  for  any  purpose  for  which  any  of  the  appro- 
priations nuide  by  this  chapter  are  availal)le. 

"Sec.  8.  That  the  terms  'State"  and  'States.'  as  used  in  this  chapter,  shall  be 
held  to  include  the  District  of  Columbia." 

Mr.  Newton.  Under  section  6  there  was  appropriated  $1,400,000  annually  for  two 
years,  beginning  with  the  fiscal  year  commencing  July  1 ,  1918,  $1,000,000  of  which  was 
to  be  paid  to  the  States  for  the  use  of  their  respective  boards  or  departments  of  health 
in  the  prevention,  control,  and  treatment  of  venereal  diseases,  that  sum  to  be  allotted 
to  each  State,  in  accordance  with  the  rules  and  regulations  prescribed  by  the  Secre- 
tary of  the  Treasury,  in  the  proportion  of  its  population  to  the  population  of  the  United 
States. 

The  Chairman.  The  specific  and  distinct  purposes  of  the  appropriation  are  set 
forth  in  the  act?   -  / 

Mr.  Newtox.  Yes,  sir. 

The  Chairmant.  Is  that  for  investigations  and  reports? 

Mr.  Newton.  As  I  understand  the  act,  it  was  passed  as  a  war-time  measure,  and 
the  appropriation  was  made  on  a  two-year  basis.  The  appropriation  has  been  con- 
tinued, but  in  a  lesser  amount.  So  far  as  the  exact  appropriation  for  this  fiscal  year 
is  concerned,  I  have  not  that  information  here,  but  I  would  like  to  put  it  in  the  record. 
The  appropriations  are  as  follows : 

1919  Army  act $2,  500,  000 

1920  Army  act  (and  re-appropriation  of  unexpended  balance) 1,  400,  000 

1921 1,  015,  000 

1922  (third  deficiency) 225. 000 

The  Chairman.  What  was  the  plan  and  scope  of  that  work?  Did  it  include  treat- 
ment, or  only  investigations  and  reports? 

Mr.  Newton.  Both,  as  I  understand  it.  Through  their  agents  they  cooperated 
-with  the  States  in  creating  the  proper  health  environment  aroimd  the  Army  camps, 
and  then  it  was  extended  further  into  the  communities  in  order  that  they  might  have 
a  healthy  environment. 

Mr.  Graham.  That  was  for  the  prevention,  control,  and  treatment  of  venereal 
disease. 

The  Chairman.  Is  the  administration  of  that  act  left  in  the  hands  of  any  central 
board? 

Mr.  Graham.  The  act  provides  that  the  duties  of  the  division  of  venereal  diseases 
shall  be  in  accordance  with  rules  and  regulations  prescribed  by  the  Secretary  of  the 
Treasury. 

The  Chairman.  There  is  no  division  of  funds  between  the  State  and  Nation,  ia 
there,  or  the  State  does  not  have  to  contribute  anything? 

Mr.  Newton.  Apparently  not. 

The  Chairman.  In  other"  words,  they  have  the  expenditure  of  United  States  money. 

Mr.  Newton.  Yes;  although  my  State  has  appropriated  money  to  assist  in  that 
work. 

The  Chairman.  Is  there  anything  further  you  desire  to  say,  Gen.  Sawyer? 

Gen.  Sawyer.  Nothing,  except  to  thank  you  all  for  the  courtesy  extended. 

The  Chairman.  We  are  greatly  obliged  to  you. 

Gen.  Sawyer.  I  Avish  vou  well  in  all  of  vour  attempts. 

The  Chairman.  The  Chair  will  call  on  Mrs.  Gibbs.  About  how  much  time  will 
you  need,  Mrs.  Gibbs? 

Mrs.  Gibbs.  I  think  about  10  or  15  minutes.     I  will  hurry  as  much  as  possible. 


136  PUBLIC   PEOTECTION   OF   MATERNITY  AND   INEANCY. 

STATEMENT   OF  MRS.    RUFUS  M.    GIBBS,    1209    ST.   PAUL    STREET, 

BALTIMORE,  MD. 

Mrs.  GiBBs.  Mr.  Chairman,  I  am  the  president  of  the  Maryland  Association  Opposed" 
to  Woman's  Suffrage.  It  has  been  sneeringly  stated  that  the  only  opposition  to  this 
bill  was  antisuffrage  opposition.  Of  course  my  own  feeling  is  that  anyone  who  thinks 
soundly  along  any  line  would  be  opposed  to  woman's  suffrage,  because  I  feel  that  it 
is  a  case  where  the  unit  is  the  family  all  through  our  civilization,  both  political  and 
social,  and  that  is  the  only  way  we  can  think.  It  is  the  only  way  the  majority  of 
women  in  this  country  think  to-day,  and  it  is  a  case  where  we  all  know  that  women 
can  only  count  politically  by  neglecting  much  more  important  work.  They  have 
no  time  to  have  watchtowers  in  Washington  or  to  have  any  lobbies  to  force  through 
special  woman's  legislation. 

I  want  to  assure  you,  gentlemen,  that  there  is  no  such  thing  as  woman's  legislation. 
Our  interests  are  identical.  The  men  and  the  women  have  worked  side  by  side  for 
centuries,  and  they  should  not  duplicate,  but  cooperate.  We  have  come  down  through 
the  ages  working  in  that  way  very  satisfactorily,  and  I  do  not  think  you  need  to  be 
railroaded  into  anything  that  is  called  woman's  legislation. 

In  my  State  the  nineteenth  amendment  has  been  twice  rejected  in  the  general 
assembly,  and  a  patriotic  body  of  men  are  fighting  it  now  in  the  courts. 

In  a  census  which  was  taken  in  a  small  way  because  it  was  done  by  our  organiza- 
tion, which  has  not  unlimited  funds,  which  some  of  the  suffragists  seem  to  have,  we 
took  a  census  of  12  centers  of  population,  and  32,100  women  were  asked  how  they  felt 
about  the  matter  in  order  to  get  the  sentiment  of  the  women  in  my  State,  and  only 
2,169  wanted  to  vote,  and  29,461  were  against  it,  and  there  were  470  who  were  indif- 
ferent. The  29,000  were  against  it  because  they  know  it  is  with  the  individaul  that 
the  woman  must  always  work,  and  it  is  a  case  of  where  we  know  that  in  making  the 
best  kind  of  citizens  we  are  doing  a  great  deal  more  for  our  Nation  than  we  can  ever 
do  in  making  laws. 

Now,  I  am  not  alone  in  this  feeling  of  opposition  to  this  maternity  bill.  As  I  have 
said,  it  is  claimed  that  there  is  only  antisiiffrage  opposition  to  the  bill,  but  we  are  a 
body  of  women  who  are  not  very  articulate;  but  do  not  think  we  are  nonexistent, 
because  we  do  speak,  and  we  will  speak  at  the  elections.  Now  that  the  vote  has  been 
forced  on  us,  we  also  vote,  and  we  stand  by  our  fathers  and  sons  and  brothers,  and 
we  do  not  stand  by  any  women  politicians. 

In  regard  to  these  other  elements  that  stand  with  us,  let  me  read  what  the  leading 
Catholic  weekly,  America,  says; 

"The  State  of  Montana,  for  instance,  recently  petitioned  Congress  to  enact  the  out- 
rageous Sheppard-Towner  maternity  bill,  and  among  the  chief  grounds  alleged  was 
the  fact  that  in  one  year  nearly  150  mothers  had  died  in  the  State  for  want  of  proper 
care.  If  that  be  true,  had  not  the  citizens  of  Montana  enough  humanity  and  initiative 
to  take  steps  to  prevent  an  abnormally  high,  if  such  it  be,  death  rate?  Or,  failing 
private  agencies  of  relief,  can  not  the  State  of  Montana  solve  this  problem  for  itself? 
Is  it  so  lost  to  independence  that  in  a  matter  affecting  the  health  regulations  it  must 
immediately  turn  to  the  Federal  Government,  thereby  confessing  its  unfitness  for 
self-government?  " 

Gentlemen,  you  have  got  to  have  things  worked  out  along  the  lines  of  local  self- 
government.  You  can  not  put  over  on  people  something  they  have  not  worked  out 
for  themselves  or  that  they  do  not  believe  in  for  themselves. 

State  rights  is  not  an  academic  question.  Do  not  think  it  was  all  settled  by  the 
Civil  War,  or,  as  some  one  said  to  me,  that  it  is  obsolete.  It  is  not  obsolete.  It  is 
based  on  common  sense,  and  in  a  great  big  country  such  as  ours  we  have  got  to  have 
the  small  unit,  and  the  States  are  those  small  units.  Some  highbrow,  who  seemed  to 
be  getting  away  from  the  traditions  that  have  made  this  country  great,  said  to  me,  ''  We 
do  not  need  these  States.  They  were  based  on  colonial  history.  Why  not  divide  the 
country  up  evenly,  so  that  a  little  State  like  Delaware  will  not  have  such  an  expensive 
legislature?  Let  us  divide  it  up  and  chop  it  all  up."  Gentlemen,  we  have  not  too 
many  traditions  now  in  the  history  of  this  country,  and  let  us  make  the  most  of  what 
we  have,  and  let  us  inspire  the  people  by  what  their  States  have  done  and  allow  the 
new  States  to  build  up  some  traditions  of  their  own.  I  think  the  idea  of  these  nomads 
who  go  around  and  come  here  to  Washington  and  look  at  a  thing  from  a  Federal  angle 
and  do  not  care  anything  about  communities  and  have  not  any  loyalty  to  communi- 
ties is  a  very  great  menace,  and  I  think  you  gentlemen  should  take  cognizance  of  that 
fact,  because  I  think  it  is  leading  us  very  disastrously;  and  when  you  get  extreme 
nationalism,  you  very  soon  begin  to  get  internationalism. 

In  regard  to  some  one  else's  testimony,  I  wrote  to  Mr.  George  W.  Wickersham  about 
this,  and  I  feel  that  he  is  a  man  who  has  a  broad  point  of  view,  and  this  is  what  he 
says: 


J 


PUBLIC   PROTECTION   OF    MATERNITY   AND   INFANCY.  137 

"I  am  not  in-sympathy  with  extondini,'  the  expenditures  of  Federal  moneys  to  pur- 
poses which,  in  my  opinion,  should  proj)erly  ])e  met  by  the  .States  themselves.  We 
are  in  ereat  danger  of  relieving  the  States  from  any  sense  of  responsibility  for  their 
own  problems  through  easy  access  to  the  National  Treasury." 

This  is  a  case  where  we  antisul'fragists  are  just  as  anxious  to  relieve  the  i  ituation 
and  to  help  mothers  and  babies  as  anybody  else.  We  are  accused  of  l)eiiig  llerods. 
Apparently  they  think  we  have  some  special  animus  against  mothers  and  babies, 
but  nothing  of  the  kind  is  true:  and  in  the  very  testimony  given  l)y  the  people  who 
want  this  bill  they  tell  how  local  agencies  are  making  headway. 

I  have  been  for  years  a  director  of  the  Babies'  Milk  i<'niid,  which  is  an  association 
for  the  prevention  of  infant  mortality.  1  was  one  of  the  pioneers  in  that  work.  We 
have  been  established  17  years  now.  Dr.  Baker  spoke  about  her  organization  having 
gone  on  for  lA  years  and  being  the  oldest  association.  I  think  that  the  Boston  associa- 
tion is  a  little  older  than  we  are,  and  Mrs.  Putnam  will  tell  you  about  that.  However, 
I  think  1  know  some  of  these  prolih^ms.  We  have  213  centers  where  mothers  and  bay)ie8 
can  be  taken  care  of  and  at  least  instructed,  and  we  have  visiting  inirses,  who  go  irtto 
the  homes  when  necessary.  We  give  medical  advice,  and  last  year  we  took  care  of 
1:3, 000  babies  at  an  expense  of  $^3,000,  which  was  just  a})Out  S5  per  baby,  as  against 
$iK)0,0()0  taking  care  of  (JO, 000  babies  in  New  York,  at  an  expense  of  $15  per  baby 
under  the  municipality  when  they  gave  no  medical  advice  or  no  nursing  care,  because 

]  they  turned  them  over  to  private  agencies  for  that  kind  of  thing. 

'  Now,  you  can  do  a  little  computation  as  to  what  would  happen  if  the  Federal  Gov- 
ernment goes  into  this  work  along  the  lines  that  the  municipality  of  New  York  has 
gone  into  it.  It  seems  to  me  the  municipality  of  New  York  can  handle  i't,  and  we  have 
a  bureau  of  child  h>'giene  in  Baltimore,  under  the  department  of  health,  and  they  do 
their  share,  but  it  is  always  a  case  of  where  you  have  got  to  give  this  help  to  the 
people  who  need  it,  and  not  let  others  who  do  not  need  it  impose  upon  you.  One 
of  the  big  j)rol)lems  we  have  is  to  see  that  the  people  who  can  pay  something  do  pay 
something.     The  idea  that  people  can  get  something  for  nothing  which  is  costing  other 

I  people  something  is  a  very  unsound  financial  principle  and  will  wreck  this  Nation, 
and  to  have  them  feel  that  they  can  simply  lie  back  on  any  government  is  not  at  all 
a  good  plan.  It  has  been  stated  here  how  eager  these  people  are  for  information. 
They  are  eager  for  information  when  they  get  sick  or  when  their  children  get  sick, 
but  when  you  try  to  tell  them  what  to  do  ])efore  they  are  sick,  you  do  not  find  that 
tremendous  eagerness  on  their  part  for  information.  I  have  talked  and  talked  with 
some  of  these  women  aliout  not  feeding  their  children  every  time  the  child  cries,  and 
do  you  think  I  make  any  progress?  No;  they  think  that  I  am  simply  full  of  new- 
fangled notions,  and  they  say  that  their  mothers  and  their  grandmothers  fed  them  every 
time  they  cried,  and  that  they  are  going  to  feed  them  whenever  they  cry;  but  let 
the  baby  become  sick,  and  then,  finally,  you  can  get  the  mother  to  realize  that  they 
should  not  feed  the  child  every  time  it  cries.  I  tried  also  to  tell  them  not  to  give  the 
baby  cabl)age  and  not  to  give  it  meat,  but  nine  times  out  of  ten  they  will  do  that, 
and  then  when  the  baby  is  sick  and  they  have  to  have  a  doctor,  they  will  ultimately 
begin  to  get  some  common  sense  about  feeding  their  children.  However,  I  do  not 
think  there  is  much  chance  of  doing  a  great  deal  with  the  adult  population.  The 
whole  thing  is,  liased  on  education,  and  the  more  you  can  get  common  sense  and 
child  hygiene  in  the  school  the  l)etter  it  will  be.  I  do  not  mean,  necessarily,  for  the 
Federal  Government  to  do  that,  but  let  the  Federal  Government  stimulate  that  work. 
It  is  the  place  of  the  Federal  Government  to  stimulate  such  work.  Do  not  subsidize 
educational  and  health  work.  You  have  to  do  some  subsidizing  in  interstate  matters, 
but  there  are  other  problems  that  the  Federal  Government  should  not  touch. 

All  I  want  to  say  in  conclusion  is  that  I  am  the  mother  of  four  children  myself, 
eo  I  do  feel  that  I  know  something  about  the  whole  prolilem  of  infant  and  maternity 
hygiene. 

I  was  on  the  council  of  defense  in  the  child  welfare  committee,  and  after  we  had  the 
weighing  and  measuring  campaign,  I  wrote  to  the  Children's  Bureau  and  asked  them 
if  they  could  not  put  out  something  in  the  way  of  a  special  appeal  from  Uncle  Sam  to 
the  children.  I  thought  if  they  would  simply  formulate  something  and  say  to  the 
children,  ''  Uncle  Sam  wants  you  to  get  enough  sleep  and  to  drink  plenty  of  milk  and 
do  not  drink  coffee  and  tea,"  that  it  would  be  very  helpful,  because  we  all  know,  of 
course,  that  we  are  influenced  by  a  patriotic  appeal,  and  the  National  Government 
could  furnish  such  an  appeal  to  the  children.  The  Children's  Bureau  told  me  they 
had  no  money  for  that  work.  They  seemed  to  have  a  lot  of  money  to  print  these 
maternity  benefit  pamphlets  and  things  of  that  sort.  Of  course,  under  the  act  under 
which  they  were  created  perhaps  they  could  not  do  exactly  what  1  suggested  unless 
you  gave  them  the  power  to  do  it,  but  let  us  give  them  the  pow«r  to  do  such  educating 
and  stimulating.  I  also  wanted  to  get  some  pamphlets  from  them  for  some  mothers 
in  a  clinic.     The  Federal  Government  has  gotten  out  something  about  the  care  of 


138  PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY. 

babies,  and  I  wrote  to  them  and  sent  money  to  pay  for  20  copies  to  give  to  these 
mothers,  and  I  was  told  I  could  only  have  one,  because  they  only  sold  them  to  indi- 
viduals. 

The  Chairman.  Mrs.  Gibbs,  I  dislike  to  interrupt  you,  but  your  time  is  up.  I  will 
say  to  you  that  a  copy  of  your  remarks  will  be  sent  to  you  and  you  will  have  the  privi- 
lege of  extending  your  remarks  before  they  are  embodied  in  the  record. 

Mrs.  Gibbs.  I  just  want  to  add  that  they  stated  they  would  commercialize  the 
pamphlet  if  they  let  more  than  one  person  at  a  time  have  it.  I  think  if  they  really 
had  the  problem  at  heart  they  could  do  a  great  deal  more  than  thev  have  done. 

Certainly  this  whole  problem  is  a  very  large  one.  In  Mother  and  Child,  the  official 
organ  of  the  American  Child  Hj'-giene  Association,  which  has  indorsed  this  1)111,  vou 
will  find  that  they  make  a  very  damaging  statement  to  their  cause  when  they  say  that 
"Child  hygiene  work  must  include  a  well-rounded  health  program  for  every' family  in 
a  neighborhood,"  which  shows  what  would  be  ultimatelv  expected  of  the  Federal 
Government.  Surely,  the  Federal  Government  can  not  be  expected  to  educate  the 
doctor,  the  mother,  and  the  mother's  husband,  as  is  deemed  necessary  by  a  physician 
who  spoke  at  a  previous  hearing  on  the  bill.  The  man  who  is  going  to  ha^^e  the  right 
^  instincts  in  regard  to  protecting  his  wife  and  child  will  need  to  be  brought  up  lay  the 
right  kind  of  mother,  and  when  he  grows  up  the  right  kind  of  a  wife  will  make  him 
eager  to  do  his  duty  by  her  and  by  his  offspring. 

In  concluding  may  I  call  your  attention  to  a  prophecy  and  a  warning  that  was 
written  by  John  Fiske  in  his  Critical  Period  of  American  History: 

"If  the  day  should  ever  arrive  (which  God  forbid)  when  the  people  of  the  different 
parts  of  our  country  should  allow  their  local  affairs  to  be  administered  from  Washington, 
on  that  day  the  progressive  political  career  of  the  American  people  will  have  come  to 
an  end  and  the  hopes  that  have  been  built  upon  it  for  the  future  happiness  and  pros- 
perity of  mankind  will  be  wrecked  forever." 

The  Chairman.  The  next  witness  is  Dr.  O'Donovan,  of  Baltimore. 

STATEMENT    OF    DR.    CHARLES    O'DONOVAN,    OF    5    EAST    RiSAD 
STREET,  BALTIMORE,  MD. 

Dr.  O'Donovan.  I  am  a  practicing  physician  in  Baltimore.  I  am  a  married  man 
with  four  children.  I  am  a  citizen  and  taxpayer  of  the  United  States.  In  1907  I 
was  president  of  the  Medical  and  Chinirgical  Faculty  of  the  State  of  Maryland,  the 
State  Medical  Society,  and  was  one  of  its  two  delegates  to  the  recent  meeting  in  Boston 
of  the  American  Medical  Society. 

I  am  opposed  to  this  bill  for  three  reasons,  the  first  of  which  is  that  it  is  a  distinct 

Mr.  Mapes  (interposing).  I  do  not  want  to  interrupt  you,  but  how  many  doctors 
attended  that  meeting  in  Boston? 

Dr.  O'Donovan.  In  the  house  of  delegates  126  were  registered;  the  total  number  of 
doctors,  from  every  State  of  the  United  States  registered  in  Boston  was  5,437.  It  is 
organized  very  much  like  the  United  States  Government  with  a  house  of  delegates, 
which  is  not  the  general  meeting,  but  each  State,  according  to  the  number  of  its 
members  in  its  State  society,  is  entitled  to  so  many  members  in  the  house  of  delegates. 
Maryland  is  entitled  to  two,  and  I  was  one  of  them. 

Mr.  Mapes.  Then  there  were  between  100  and  200  men  representing  the  profession 
there? 

Dr.  O'Donovan.  Yes;  in  the  house  of  delegates  which  is  the  business  part  of  the 
association.     The  scientific  sessions  were  attended  by  5,437. 

For  three  reasons  I  am  opposed  to  this  bill.  The  first  one  is  that  it  is  a  distinct, 
unjustifiable  invasion  by  the  Federal  Government  of  the  pri^dleges,  immunities,  and 
the  duties  of  each  State.  It  places  in  the  hands  of  a  chief  of  bureau,  in  the  Depart- 
ment of  Labor,  such  power  of  direction  and  coercion  of  the  various  States  as  to  be  utterly 
destructive  of  our  theory  of  government.     It  is  an  unholy  deification  of  bureaucracy. 

Second,  it  means  an  enormous  expense,  because  the  initial  expense  is  only  an 
entering  wedge.  I  will  show  in  a  few  moments  that  it  would  be  impossible  to  do 
what  is  proposed  with  this  amount  of  money.  I,  as  a  citizen  and  as  a  taxpayer,  con- 
tent that  you  should  not,  as  our  Representative,  saddle  upon  us  any  further  expenses. 
Economy  is  necessary  at  the  present  time.  In  governmental  financing  we  do  not 
know  where  we  stand.  The  papers  we  read  this  very  day  speak  of  $300,000,000  addi- 
tional as  being  necessary  to  be  appropriated  for  the  debts  of  the  Shipping  Board,  and 
any  additional  expense,  either  immediate  or  prospective,  would  be  unwise.  This 
is  a  continuing  appropriation,  as  I  will  show  in  a  moment;  a  form  of  appropriation 
which  invites  extravagance.  This  is  not  the  time  to  undertake  any  experiments  of 
character  which  will  cause  so  great  an  expense. 

And  the  third  reason,  I  am  opposed  to  it  is  because  it  can  not  possibly  perform  what 
it  appears  to  promise.     This  will  appear  as  we  read  the  bill  itself. 


th 


PUBLIC   PROTECTIOISr   OF   MATERNITY  AND  INFANCY.  139 

The  first  thin^  I  object  to  in  the  bill  is  on  line  6  of  the  first  page  where  it  says,  "  For 
uiiC  pm-pcse  of  cooperating  with  the  States."  Very  few  States  desire t]nscooj)eration , 
and  surely  no  State  would  welcome  such  coojjorutiou  as  is  ])ro])osed  in  tliis  bill.     The 

Purposes  of  the  bill  are  good  but  its  methods  are  bad,  and  the  bill  is  unnecessary. 
n  the  beginning,  it  says  "cooperate,"  page  1,  line  8,  and  later  on  it  coerces  the  States 
by  putting  it  within  the  power  of  the  chief  of  the  Children's  Bureau  to  withhold, 
page  8,  line  4,  from  the  States  the  moiiey  to  wliich  they  will  be  entitled  under  the  bill, 
and  wliich  tlu^y  are  themselves  taxed  to  ])ay.  The  United  States  (lovernnu^nt  gives 
back  to  the  States  money  it  has  taken  from  the  States.  This  (Government  does  not 
create  any  money,  but  accpiires  it  by  taxation  within  the  States.  It  takes  the  State's 
money  out  of  onc^  ])()cket  and  then  giAes  it  back  into  the  other,  or  withholds  it  at  the 
discretion  of  the  ciiief  of  the  Children's  Bureau.  Let  the  States  do  this  work  them- 
selves. It  is  manifestly  their  work,  and  in  most  instances  is  being  very  well  done 
already.  Surely  the  United  States  Government  has  encnigli  to  do  without  thus  med- 
dling in  purely  local  affairs. 

In  section  2,  on  the  second  page,  line  7,  there  is  this  language:  "is  penuanently 
authorized  to  be  a])propriated  *  *  *  $480,000."  Here  is  a  continuing  appropria- 
tion. It  is  one  of  those  continuing  a]>propriations  which  all  taxpayers  anrl  all  Con- 
gressmen are  now  endeavoring  to  get  away  from.  A  continuing  aiipropriation  is  like  a 
bad  habit-  easy  to  begin,  but  next  to  impossible  to  avoid  or  cont  rol .  This  small  ainount 
of  $480,000  a  year  is  a  permanent  substructure,  upon  which  foundaticm  can  be  biiilt  any 
huge  amoimt  which  subsequently  may  be  desired .  Then  it  appropriates  SI  ,000,000  for 
the  administration  of  the  work,  to  be  divided  up  amongst  the  different  States  accord- 
ing to  their  popidation.  To  accomplish  anything  this  amoimt  of  money  must  gi'ow — 
$1,000,000  divided  up  amongst  105,000,000  people  in  the  United  States  amounts  to 
little.  There  are  5,000,000  prospectiA-e  beneficiaries  under  this  bill  in  the  country, 
because  there  are  2,500,000  children  born  in  the  United  States  every  year,  and  inas- 
ngiiich  as  the  pregnant  time  or  the  nursing  time  of  every  woman  lasts  usually  through 
two  years,  there  must  be  5,000,000  women  who  are  entitled  to  benefit  under  this 
appropriation.  It  is  true  that  this  amount  must  be  matched  by  the  States,  if  their 
citizens  are  to  acquire  any  interest  in  it  at  all.  If  they  do  not  match  it  they  receive 
nothing.  They  do  not  escape  taxation,  but  what  they  pay  in  taxes  is  distributed 
anumgst  the  more  subservient  States.  Many  of  you  are  married  and  are  familiar  with 
(the  expenses  of  pregnancy  and  parturition.  Do  you  think  the  sums  appropriated  by 
this  bill  at  all  sutficient  to  handle  such  cases?  It  would  be  about  20  cents  for  each 
pregnant  woman.  As  a  doctor,  1  never  heard  of  such  a  thing.  I  foresee  early  efforts 
to  increase  these  appropriations  enormously.  It  seems  to  point  directly  to  pensions 
for  the  pregnant.  It  opens  up  unlimited  possibilities  botli  socialistic  and  bureau- 
cratic, a  cycle  of  expensive  administration  that  bewilders  me. 

Now,  no  part  of  this  money  is  to  be  given  to  any  State  until  the  State  shall  have 
appropriated  an  equal  sum.  So  that  the  increasing  appropriations  of  the  Government 
call  for  nearly  double  the  amounts,  and  all  from  the  taxpaying  people  already  groaning 
under  their  load  of  taxation.  No  wonder  we  fear  the  too-evident  possibilities  of 
this  bill. 

Section  3  provides  that  the  Children's  Bureau  of  the  Department  of  La))or  shall 
administer  the  pnudsions  of  this  act,  and  the  chief  of  the  Children's  Bureau  .'^hall  be 
the  executive  officer.  If  time  permitted,  I  should  like  to  show  you  what  are  the 
duties  (p.  351  of  the  Congre-sional  Directory)  of  the  Children's  Bureau.  The  act 
which  created  it  did  not  say  anything  at  all  about  activities  of  this  sort,  but  it  is  full 
of  other  work.  Any  additional  Avork  in  the  bureau  mean^  an  increase  of  expenr:e — 
in  thi.s  case  a  very  great  increase.  This  must  be  paid  for  by  the  taxpayer.-;,  and  there 
will  be  an  enormous  expansion  of  appropriations.  The  Chief  of  the  Children's  Bureau 
i?  given  under  this  bill  most  unusual  power.  It  is  true  that  she  is  authorized  to  form 
a  committee  ^r  consultation.  The  language  is,  "The  Chief  of  the  Children's  Bureau, 
as  executive  officer,  is  hereby  authorized  to  form  an  advi-ory  committee  to  consult 
with,"  etc.  NoAV,  who  is  to  be  this  committee?  You  will  l)e  astonished,  although 
I  suppose  you  have  already  read  it..  The  committee  is  to  consist  of  the  Secretary  of 
Agriculture — this  seems  a  joke;  l)oll  weevil  and  hog  cholera  and  peanuts  and  baVues; 
tlie  author  of  this  Inll  surely  nodded  at  this  stage — the  Surgeon  General  of  the  United 
States  Public  Health  Service,  and  I  think  he  ha«  his  hands  pretty  full  with  the  United 
States  Public  Health  SerAdce  along  other  lines,  and  the  United  States  Commi-sioner 
of  Education,  whose  mind  should  be  so  engrossed  by  other  grave  studies  of  child  life 
that  he  can  have  little  time  to  study  the  needs  of  pregnant  or  nursing  women.  I 
think  the  Chief  of  the  Children's  Bureau  would  get  but  little  help  from  such  a  com- 
mittee. She  can  consult  Avith  them  or  not,  as  she  may  elect,  but  she  can  disregard 
9ntirely  any  advice  they  may  give — I  say  she,  because  the  chief  of  this  bureau  happens 
to  be  a  lady  at  present,  but  it  may  be  a  man. 

I  come  now  to  the  States. 


140  PUBLIC   PEOTECTION    OF   MATERNITY  AND   INFANCY. 

"That  in  order  to  secure  the  benefit  of  the  appropriations  authorized  in  section  2 
of  this  act,  any  State  shall,  through  the  legislative  authority  thereof,  accept  the  pro- 
visions of  this  act  and  designate  or  authorize  the  creation  of  a  State  agency  with  which 
the  Children's  Bureau  shall  have  all  necessary  powers  to  cooperate." 

That  is  the  point,  of  course,  that  Judge  Towner  brought  out  day  before  yesterday 
in  his  cross-examination  of  one  of  the  \vitnesses.  He  says  that  the  power  is  in  the 
State=^.  Yes;  the  States  are  supposed  to  have  these  bureaus,  and  they  probably  have 
thena,  and  they  can  cooperate  with  the  bureau  if  they  desire  to  do  so.  Suppose  they 
do  not  msh  to  cooperate;  they  are  taxed  anyhow.  If  they  do  not  coope^'ate,  they  do 
not  get  back  any  of  the  money.  And  who  is  to  say  whether  they  are  cooperating  or 
not — the  Chief  of  the  Children's  Bureau,  as  will  appear  in  a  few  moments. 

Then  follows  the  details  of  admini'tration,  and  it  is  provided  that  any  money  not 
used  shall  be  turned  back  into  the  Treasury,  to  be  redivided  subsequently. 

The  Children's  Bureau  is  authorized  to  employ — here  comes  the  pickings — from 
the  eligible  lists  of  the  Civil  Ser^dce  Commission  such  assistants,  clerks,  and  other 
persons  in  the  city  of  Washington — and  elsewhere,  to  purchase  such  supplies,  material, 
equipment,  etc.,  and  it  is  provided  in  another  part  of  the  bill  that  not  more  than  .5 
per  cent  of  the  gross  amount  shall  be  appropriated  for  this  particular  part,  the  admin- 
istration of  the  act.  Now.  I  ask  you  gentlemen,  as  Congressmen,  living  here  in 
Washington  and  knowing  what  clerks  can  do,  how  many  clerks  or  how  much  adminis- 
tration in  Washington,  and  presumably  in  the  States  also,  although  it  does  not  say  so, 
can  be  had  for  5  per  cent  of  .$1,000,000,  or  even  $2,000,000,  if  they  match  it,  and 
1480,000.  You  know  very  well  that  that  will  not  go  very  far  in  the  purchase  of 
equipment  and  the  employment  of  nurses,  so  that  one  of  two  things  must  happen, 
the  compensation  must  be  increased,  or  very  little  will  be  accomplished.  You  have 
a  permanent  appropriation  here  to  which  any  amount  can  be  added,  and  you  know 
perfectly  well  the  tendency  of  the  various  bureaus  once  they  get  a  foundation.  It 
simply  grows  and  grows  and  grows;  and  everybody  pays  his  share,  although  his  burden 
of  taxation  is  already  most  distressing.  I,  as  a  taxpayer,  oppose  most  strenuously 
this  increased  burden;  and  many  others  with  whom  I  have  discussed  this  bill  are 
unanimously  opposed  to  it  for  that  same  reason. 

Section  8  provides  that  any  State  desiring  to  avail  itself  of  the  benefits  of  this  act 
shall  submit — now,  first,  they  said  cooperate,  page  1,  line  6,  and  now  the  bill  says, 
"shall  submit  to  the  Children's  Bureau  for  its  approval  its  plans,  and  those  plans  shall 
be  in  conformity  with  the  provisions  of  this  act,"  etc.  The  States  make  the  plans  of 
administration  for  themselves,  and  must  then  submit  those  plans  to  the  chief  of  the 
Children's  Bureau  who  approves  them  or  not.  Now,  this  particular  part  of  the  bill 
I  can  not  discuss  fully  because  of  the  short  time  allowed  me,  but  it  is  vehemently 
opposed  by  all  thoughtful  people  I  have  talked  with  in  reference  to  it.  There  is 
where  the  (^overmnent  is  interfering  most  improperly  with  the  activities  belonging 
solely  to  individual  States.  My  own  State  of  Maryland,  which  the  chairman  was  kind 
enough  to  refer  to,  has  this  work  going  well  in  hand.  Tverything  is  going  on  excel- 
lently, and  why  should  we  come  down  here  to  Washington  and  ask  the  chief  of  the 
Children's  Bureau  to  approve  what  is  perfectly  satisfactory  to  us'^  We  avf  paying 
for  it  with  our  own  money,  and  managing  it  satisfactorily  in  our  own  way.  Why  should 
we  ask  of  the  Goveriunent  for  a  return  of  certain  taxes  and  for  their  approval?  Cer- 
tainly we  prefer  oiu'  own  method,  and  are  willing  to  pay  ourselves  for  our  own  work.  S 
Suppose  the  chief  of  the  bureau  should  say,  "I  do  not  approve  of  this  thing  at  all  as  » 
Maryland  does  it;  you  must  do  it  in  the  way  I  tell  you."  What  are  we  going  to  do? 
If  we  should  refuse  to  submit  to  the  dictation  of  the  chief  of  the  Children's  Bureau, 
what  money  we  should  have  been  entitled  to  would  be  withheld  from  us  and  given 
to  States  more  submissive;  and  that  applies  not  only  to  the  State  of  Marylahd  but  to 
every  other  State.  I  ask.  Is  this  just?  There  is  not  a  State  in  this  Union  which  could 
not,  if  it  would,  carry  out  this  work  far  better  than  any  central  bureau.  It  is  a  local 
question  and  should  be  managed  locally. 

The  bill  also  provides  that  the  plans^  shall  be  in  conformity  with  the  provisions  of 
this  act.  Who  is  to  determine  that?  This  decision,  of  greatest  importance,  is  given 
absolutely  to  the  Chief  of  the  Children's  Bureau,  and  I  do  not  think  there  is  a  m.an  or 
woman  in  the  United  States  who  possesses  or  should  possess  such  power.  One  indi- 
vidual shall  determine  concerning  the  health  and  the  welfare  of  about  5.CC0,C0O  women 
in  their  most  important  time.  It  is  the  same  thing  that  Mr.  Hawes  objected  to  when 
he  said  he  thought  it  was  a  vrey  unfortunate  thing  in  the  bill.  The  powers  thus  dele- 
gated should  be  very  carefiilly  limited;  they  should  be  defined  most  strictly  and  not 
left  to  the  whim  of  a  head  of  a  bureau.  Such  legislation  is  most  reprehenf^ible,  es- 
pecially in  a  democracy,  and  lays  the  foundation  for  autocracy  or  revolution.  As  a  ij, 
father  I  could  not  bear  to  look  my  children  in  the  face  if  I  should  tamely  submit  to  the  ([ 
enactment  of  such  laws.     It  may  easily  lead  to  such  tjTanny  as  our  forefathers  opposed 


4 


la 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  141 

in  open  l.altlo.  .  I  ]jray  you,  gentlcnu-ii,  think  .-criously  Ijt-foro  von  rocommend  Hiirh 
legislation  in  this  free  foiintry. 

p-romtheclerisionof  the  fhiefof  bureau  there  iw  one  appeal.    Onpaj^eS,  linef).  ilnayH: 
"If  any  allotment  is  withheld  from  any  State,  the  State  agency  of  such  State  may 
appeal  to  the  Secretary  of  Labor." 

The  Secretary  of  Labor  a])points  the  head  of  the  Children's  Bureau;  it  i.s  in  hie  de- 
partment. It  is  an  appeal  from  a  sulxirdinate  to  his  chief.  What  kind  of  a  ruling 
would  you  get  uiuler  those  circumstances?  \\hat  hajjpens  if  the  State  should  ajipea^ 
and  say,  "We  will  not  accept  that  ruling."  The  liureau  will  say.  "This  is  our  (inal 
decision;  acce])t  it  or  you  get  no  money."  That  may  lie  a  small  thing  in  Ne\ada, 
which  i)ays  very  litlte  in  taxes,  but  to  the  great  State  of  New  York  it  would  l;e  a  dilYer- 
ent  matter.  The  principle  is  wrong.  No  individual  should  have  such  power  over  any 
State.  ^ 

Section  10  of  the  liill  provides: 

"That  the  facilities  ])rovided  for  any  State  agencies  cooperating  under  the  provisions 
of  this  act  .shall  be  available  for  all  residents  of  the  State." 

Can  anybody  tell  me  how  5,000,00(1  women  could  avail  themselves  of  this  so  as  to 
v^ot  much  out  of  it?  The  act  appropriates  ?1,()00,000  and  calls  upon  the  States  to 
appropriate  another  Sl.,p00,P0O.  It  does  not  say  whether  that  is  in  addition  to  what 
is  already  being  approi)riated  for  this  work  in  different  States.  This  to  me  seems  a 
very  serious  defect  in  the  bill.  When  we  propose  to  spend  millions,  we  should  A'ery 
carefully  define  exactly  how  and  for  what  these  millions  are  to  be  spent.  No  loophole 
should  be  left  through  which  additional  expenditures  could  be  passed,  money  is  too 
scarce  in  the  people's  homes  to  have  it  wasted  by  carelessness  at  Washington. 

This  bill  provides  that — 

'On  or  before  the  1st  day  of  January  and  quarterly  thereafter  the  Children's  Bureau 
shall  certify  to  the  Secretary  of  the  Treasury  the  amount  to  which  each  State  is  en- 
titled under  the  provisions  of  this  act." 

That  is  the  way  the  States  get  the  money.  Every  three  months  they  have  to  make 
a  report,  a  statistical  report.  E^'ery  three  months.  Thus  often  the  State  bureau 
must  make  a  report  to  the  head  of  the  Children's  Bureau  in  Washington  as  to  what  is 
going  on;  how  the  money  is  being  spent,  and  how  many  mothers  are  pregnant; 
how  many  children  are  nursing,  etc.  They  will  have  to  make  reports  everv  three 
months  to  cover  5,000,000  women  and  2,500,000  babies.  You  can  readily  understand 
that  5  per  cent  of  an  appropriation  of  this  sort  mil  hardly  begin  to  furnish  statistics 
Df  this  sort,  (insider  for  a  moment  the  offices  and  office  force  required  to  handle  and 
iigest  such  masses  of  statistics.  Remember  what  happened  when  statistics  of 
1,000,000  men  were  handled  during  our  late  war,  and  this  bill  proposes  to  tabulate 
md  care  for  7,500,000.  It  is  entirely  too  much  to  call  upon  the  people  to  finance.  No 
wie  can  possibly  foresee  the  cost  of  it;  it  is  not  for  one  or  two  years,  but  permanently. 
;;onsider  the  enorniity  and  the  expense  of  the  old  pension'bureau,  which  handled 
250,000;  but  this  bill  smilingly  attempts  the  impossible  when  it  assumes  charge  over 
^500,000. 

What  does  it  do  for  the  women  and  children  themselves?  Apparently  nothing 
jeyond  "popular  nontechnical  instruction."     fP.  7,  line  3. ) 

Section  13  of  the  bill  pro^ddes: 

"That  no  portiion  of  any  moneys  apportioned  under  this  act  for  the  benefit  of  the 
states  shall  be  applied,  directly  or  indirectly,  to  the  purchase,  erection,  preservation, 
ir  repair  of  any  building  or  buildings  or  equipment,  or  for  the  piu'chase  or  rental  of 
my  buildings  or  lands." 

It  is  one  thing  to  tell  people  how  to  take  care  of  themselves;  it  is  quite  another  to 
lave  them  do  it.  Lectiu-es,  letters,  printed  reports,  and  statistics  may  be  good  in 
hemuselves.  but  they  mean  nothing  to  those  for  whose  good  this  bill  is  intended.  My 
■xperience  teaches  me  that  it  will  be  only  money  thrown  away.  It  will  pay  salaries 
o  a  good  many  clerks,  it  will  make  jobs  for  place  hunters;  but  its  enormous  expense 
nil  produce  no  results  to  justify  it. 

In  the  act  creating  the  Cliildren's  Bureau,  to  which  I  ask  yoiu-  attention  for  just  a 
Qoment,  you  will  see  that  the  Children's  Bureau  already  has  authority  to  collect 
fcatistics  arid  make  reports  on  these  matters.     It  says: 

"That  said  bureau  shall  investigate  and  report  to  said  department  upon  all  matters 
•ertaining  to  the  welfare  of  children  and  childlife  among  all  classes  of  our  people,  and 
hall  especially  investigate  the  questions  of  infant  mortality,  the  birthrate,  orphanage, 
-ivenile  coui'ts,  desertion,  dangerous  occupations;  accidents  and  diseases  of  children, 
mployment,  legislation  affecting  children  in  the  several  States  and  Territories. 
|he  chief  of  said  division  may  from  time  to  time  publish  the  results  of  these  investiga- 
ions  in  such  manner  and  to  such  extent  as  may  be  prescribed  by  the  Secretary  of 
'ommerce  and  Labor." 


ii 


142  PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY. 

That  seems  sufficiently  broad.  This  bill  gives  the  Children's  Bureau  an  opportunity 
to  spend  more  money  on  reports,  bad  enough  in  itself,  but  it  also  gives  to  its  chief  the 
tremendous,  indefinite,  autocratic  power  over  the  States  already  referred  to. 

The  Chairman.  Doctor,  you  have  three  minutes  remaining. 

Dr.  O'DoNovAN.  I  will  conclude  in  that  time. 

Going  back  to  my  first  proposition;  it  is  not  the  business  of  the  United  States  to 
undertake  this  activity,  the  indefinite  "general  welfare-'  clause  of  the  Constitution 
must  be  strained  greatly  to  include  this  very  specific  activity.  It  is  a  matter  entirely 
outside  of  the  powers  delegated  to  the  United  States;  moreover,  it  is  already  being 
done  very  well  by  the  States  themselves.  It  gives  power  to  the  United  States  Gov- 
ernment to  coerce  the  States  in  matters  which  are  entirely,  as  we  understand  the 
Constitution  of  the  United  States,  within  the  rights  of  the  States.  How  this  can  be 
put  under  the  general  welfare  clause,  in  the  preamble  and  the  first  article  of  the 
Constitution  of  the  United  States,  defining  the  powers  of  Congress,  exceeds  my  under- 
standing. The  tenth  article  (amendment)  of  the  Constitution  offered  by  Massachu- 
setts, expressly  reserves  such  powers  to  the  States,  as  you  gentlemen  perfectly  well 
know.  It  puts  into  the  hands  of  the  head  of  the  Children's  Bureau  autocratic  powers, 
which  no  citizen  of  the  United  States  who  loves  liberty  can  consider  without  horror  and 
anxiety.  It  furnishes  opportunities  for  the  invasion  of  private  rights — I  was  about 
to  say,  almost  as  much  as  we  have  in  the  Volstead  act.  There  is  too  much  Govern- 
mental interference  in  private  affairs,  at  the  present  time.  The  most  intimate  human 
relations,  a  most  tender  subject  for  discussion,  the  most  private  time  of  a  woman's 
life  is  interfered  with,  or  can  be  interfered  with,  by  hired  public  officials  under  biu'eau- 
cratic  authority.  I  have  no  doubt  that  tliis  l^ill,  if  it  should  pass,  will  be  administered 
in  a  way  that  is  utterly  repulsive  to  our  present  conception  of  private  family  rights. 
It  implies  that  pregnancy  and  maternity  are  not  properly  handled  now.  As  a  phy- 
sician and  as  a  father,  I  protest  against  such  a  libel.  The  sacred  states  of  probable 
and  actual  maternity  are  safeguarded  now  by  the  tenderest  care  throughout  this  land. 
Maternity  in  these  United  States  needs  no  "public  protection." 

Concerning  the  second  point,  I  think  you  will  agree,  having  in  mind  what  has 
occun'ed  in  the  Shipping  Board,  that  this  is  no  time  for  making  experiments  of  an 
expensive  nature.  This  is  the  time  for  retrenchment.  The  people  of  this  country 
everywhere  are  groaning  under  the  burdens  of  taxation;  I  suppose  you  gentlemen 
feel  it  yourselves.  I  know  there  are  others  who  do.  This  is  no  time  for  this  experi- 
ment which  promises  to  be  very  expensive.  To  force  it  upon  a  people  staggering 
under  a  debt  of  twenty-four  billions  would  be  utterly  reprehensible  in  Congress. 
When  we  chose  this  Congress  it  was  distinctly  understood  that  economy  should  be 
enforced  rigidly.  I  am  sure  I  voted  for  Mr.  Linthicum  a?  my  Representative  with 
that  understanding.  Seven  million  majority  swept  out  the  old  administration  that 
incurred  our  great  debt,  and  now  we  call  upon  you  to  carry  out  our  demand  for  retrench- 
ment. The  people  have  ordered  and  expect  an  economical  administration;  they 
expect  this  Government  to  be  even  parsimonious  for  the  present  and  not  to  embark 
on  these  expensive  experiments  which  are  fraught  with  such  signal  opportuniti<3s 
for  large  expenditures,  causing  the  taxpayers  to  lie  awake  at  night.  Do  not  build 
any  more  bureaus  that  will  produce  no  results,  as  far  as  we  can  see,  except  to  increase 
the  number  cf  officeholders  at  the  expense  of  the  taxpayer. 

The  Chairman.  We  are  very  much  obliged  to  you,  Dr.  O'Donovan. 

(Thereupon  the  committee  adjourned  to  meet  in  executive  session  at  2  o'clock  p.m.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  op  Representatives, 

Friday,  July  22,  1921. 
The  committee  met  at  10  o'clock  a.  m.,  Hon,  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

The  Chairman.  If  the  committee  will  come  to  order  we  will  proceed  with  the 
hearing. 

The  Chair  will  call  on  Mr.  Adriaans,  who  will  be  given  20  minutes  in  which  to 
make  his  statement. 

STATEMENT  OF  MB.  JOHN  H.  ADRIAANS,  ATTORNEY,  56  C  STREET 
NW.,  WASHINGTON,  D.  C. 

Mr.  Adriaans,  The  bill,  S.  1039,  and  its  report,  61,  Sixty-seventh  Congress,  while 
similar  to  S,  3259,  calendar  602,  and  its  report,  650,  of  the  Sixty-sixtl  Congress,  second 
session,  which  was  practically  identical  with  H.  R.  10925  of  the  Sixty-sixth  Congress, 
second  session,  are  not  the  same. 


toi 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  143 

The  amount  therein  named  of  $4,000,000  has  been  reduced  to  $1,480,000,  and  other 
changes  have  )>een  made. 

Mr.  Newton.  I  wish  the  witnass,  before  he  proceeds,  would  give  us  his  name  and 
business. 

Mr.  Adriaans.  I  have  done  so. 

Mr.  Newton.  Will  you  please  repeat  it. 

Mr.  Adkiaans.  My  name  is  John  H.  Adriaans;  I  am  an  attorney  of  Washington, 
D.  C,  and  a  member  of  the  bar  of  the  Suy)reme  Court  of  the  United  States. 

Mr.  Newton.  Do  you  ai)pear  for  yourself? 

Mr.  Aduiaans.  Yes;  I  do  not  represent  any  organization. 

The  Chairman.  You  may  proceed. 

Mr.  Adriaans.  A  comparison  of  Report  Gl,  Sixty-seventh  Congress,  first  session, 
page  3,  with  Report  650,  Sixty-sixth  Congress,  second  session,  page  4,  will  show 
identical  indorsers;  and  whether  they  indorsed  S.  3259  of  the  Sixty-sixth  Congress 
or  S.  1039  of  the  Sixty-seventh  Congress,  does  not  appear  satisfactorily. 

At  the  threshold  of  the  consideration  of  S.  1039  are  confronted  with  the  jurisdic- 
tional question  whether  the  bill  contemplates  medical  or  education  service.  *In  the 
former  event  it  belongs  to  the  Committee  on  Interstate  and  Foreign  Commerce,  having 
control  over  the  Public  Healtli  Service;  in  the  latter  event,  it  belongs  to  the  Committee 
on  Education.     The  bill  internally  suggests  the  latter  reference. 

The  jurisdictional  question  involves  the  scope  of  this  bill  as  follows: 
,     First,  does  it  involve  delivery  of  the  child?     It  is  then  medical  in  the  first  degree. 

Second,  does  it  involve  incidental  aid  in  delivery?  It  is  medical  in  the  second 
degree. 

Third,  does  it  involve  prenatal  and  postnatal  advice?  It  is  then  educational  in 
the  third  degree. 

The  bill  says  that  its  purpose  is,  "promoting  the  care  of  maternity  and  infancy  in 
the  several  States;  to  provide  instruction  in  the  hygiene  of  maternity  and  infancy.  " 

The  bill  does  not  contemplate  supervising  delivery  of  the  child,  or  prenatal  or  post- 
natal incidents  thereof.  It  aims  rather  at  teaching  hygiene  on  both  sides  of  the  princi- 
pal event,  as  well  for  the  benefit  of  the  prospective  mother  as  of  the  child. 

The  indefinite  words  "promoting  the  care  of  maternity  and  infancy"  of  section  1 
are  attempted  to  be  clarified  by  the  words  "providing  the  services  and  facility  spe- 
cified in  this  act,  "  in  section  2,  which,  in  turn,  are  made  more  definite  by  the  words 
"instruction  to  the  residents  of  the  various  States  on  the  hygiene  of  infancy  and  mater- 
nity "  of  section  9. 

It  is  apparent  then  that  instruction  is  intended  by  the  bill,  which  indicates  that 
the  Committee  on  Education  is  the  proper  forum  to  consider  the  same;  and  the  words 
"qualified  lecturers"  in  section  9  confirms  this  view. 

If  the  bill  is  medical. in  its  nature,  and  is  properly  before  the  present  committee 
because  of  its  jurisdiction  over  the  Public  Health  Service,  then  as  a  logical  conse- 
quence, administration  of  the  fund  provided  thereby,  should  be  under  the  control 
of  the  Public  Health  Service,  and  not  under  the  control  of  the  Children's  Bureau. 

The  bill  lodges  entirely  too  much  power  in  the  chief  of  this  bureau,  for  which  no 
previous  aptitude  has  been  exhibited.  The  mere  fact  that  this  bureau  has  a  staff  of 
female  physicians  for  consultation,  does  not  alter  the  responsibility  of  the  chief,  a 
lay  person. 

Whether  the  bill  encroaches  on  the  power  of  the  States,  is  a  matter  which  I  desire 
to  discuss  with  you.  In  that  connection,  if  the  chairman  please  and  gentlemen  of 
the  committee,  I  shall  go  very  briefly  into  a  little  outline  of  the  contemplated  functions 
assigned  by  the  founders  of  our  Constitution  to  the  States  on  the  one  side  and  to  the 
Federal  Government  on  the  other. 

By  Article  I,  section  1,  of  the  Constitution,  we  are  advised  that  "all  legislative 
powers  herein  granted  shall  be  vested  in  the  Congress  of  the  United  States.  " 

And  by  sections  8  and  9  of  Article  I,  all  the  powers  granted  are  enumerated;  all 
others,  not  granted,  are  reserved  to  each  State  by  amendments  9  and  10. 

The  only  clause  that  I  apprehend  has  any  relevancy  to  the  matter  now  engaging 
the  attention  of  this  committee  is  clause  1  of  section  8  of  Article  I,  which  provides 
for  the  general  welfare. 

Now,  there  is  in  this  country  a  dual  form  of  government,  whereby  a  citizen  of  a 
State  owes  supreme  allegiance  to  his  State  as  to  all  matters  within  its  domain,  and 
the  same  person,  as  a  citizen  of  the  United  States,  owes  supreme  allegiance  to  the 
Federal  Government  as  to  all  matters  within  its  sphere. 

Where  is  the  line  of  demarcation  between  the  two  governments?    All  powers  not 
given  to  Congress  by  the  Constitution,  by  sections  8  and  9  of  Article  I,  are  reserved 
to  the  States  by  amendments  9  and  10. 
Each  State  is  a  sovereign,  having  a  republican  form  of  government. 


144  PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY. 

Any  encroachment  by  the  Federal  powers  on  the  State  powers  is  to  be  as  jealously- 
combated  as  an  encroachment  by  the  State  powers  on  the  Federal  powers.  Each 
must  maintain  its  sphere.  The  mingling  of  State  and  Federal  funds  under  Federal 
control  violates  the  autonomy  of  the  State,  and  encroaches  the  State  powers  by  the 
Federal  powers;  deprivation  of  Federal  fund  follows  violation  of  Federal  control. 

In  this  connection,  if  you  please,  Mr.  Chairman  and  gentlemen  of  the  committee, 
I  have  a  decision  of  the  Supreme  Court  of  the  United  States  which  is  exactly  in  point. 
It  is  the  case  of  South  Carolina  v.  The  United  States,  decided  in  1905,  the  decision 
being  found  in  the  One  hundred  and  ninety-ninth  United  States,  437.  In  that 
case,  the  court  says: 

' '  The  National  Government  is  one  of  enumerated  powers,  and  a  power  enumerated 
and  delegated  by  the  Constitution  to  Congress  is  comprehensive  and  complete, 
without  other  limitations  than  those  found  in  the  Constitution  itself.  To  preserve 
the  even  balance  between  the  national  and  State  governments  and  hold  each  in  its 
respective  sphere  is  the  duty  of  all  courts,  and  preeminently  of  this  court." 

So  I  take  it  that  you  are  confronted  at  the  threshold  of  this  question  with  the 
matter'of  whether  or  not  this  bill  encroaches  on  the  State  powers.  And  correlative 
to  that  is  the  question  whether  its  enactment  produces  duplication  of  State  with 
Federal  service.     In  my  judgment  it  does. 

Whether  the  bill  is  consistent  with  the  present  policy  to  reduce  expenditures  and 
taxation.  In  that  connection,  allow  me  to  invite  attention  to  the  Reavis  resolu- 
tion, which  aims  at  preventing  duplication  of  present  service,  and  which  was  passed 
overwhelmingly  in  the  present  Congress  and  is  now  being  executed.  As  to  the 
policy  of  the  Republican  Party  in  reducing  expenditures  and  reducing  taxation,  I 
have  here  an  extract  from  the  Evening  Star  of  November  19,  1920,  in  which  is  an 
interview  with  Gov.  Coolidge,  of  Massachusetts,  then  Vice  President  elect,  in  which 
he  indicated  that  the  policy  of  the  Republican  Party  was  in  the  direction  of  dimin- 
ishing taxes  and  expenses  of  Government.  Will  I  be  permitted  to  put  that  into 
the  record? 

The  Chairman.  Yes. 

(The  newspaper  extract  referred  to  is  here  printed  in  full,  as  follows:) 

"peace  will  take  time,   declares  gov.  coolidge — PREDICTS  NEW  ADMINISTRATION 
WILL  TAKE  STEPS  TO  ELIMINATE  HIGH  COST  OP  LIVING  AND  REVISE  TAXES. 

"BosTOii,  November  19. 

"Gov.  Coolidge,  Vice  President-elect,  in  an  address  before  the  Lincoln  Club  last 
night,  said  that  it  was  'going  to  take  time  to  make  an  American  peace  that  will  be 
satisfactory  to  the  American  people,  and  until  this  is  done  the  new  administration 
will  not  have  much  time  for  economic  questions.' 

■'He  predicted,  however,  that  the  new  administration  will  take  steps  to  eliminate 
'the  present  high  cost  of  government'  and  'revise  the  taxation  system.' 

■'"The  Republican  Party  has  always  been  able  to  end  extravagance,'  he  said,  'and 
when  this  is  done  and  done  thoroughly,  I  think  we  shall  see  a  great  reduction  in  the 
cost  of  living,  for  high  cost  of  government  always  means  that  high  cost  of  living  is 
rampant.'  He  urged  the  people  to  have  patience  until  the -many  necessary  reforms 
can  be  brought  about." 

Mr.  Adriaans.  And,  also,  I  wish  to  put  into  the  record  an  article  taken  from  the 
Evening  Star  of  July  20,  1921,  showing  that  Gen.  Dawes  is  aiming  to  reduce  the 
expenditures  of  the  different  departments  of  the  Government,  and  while  other  de-  i 
partments  of  the  Government  are  vying  with  each  other  in  aiding  Gen.  Dawes  in 
his  efforts,  the  Labor  Department  has  only  offered  to  reduce  its  expenditures  by 
§10,000,  when  other  departments  are  going  into  the  millions  in  cutting  their  ex- 
penditures. 

Mr.  Johnson.  Mr.  Chairman,  I  do  not  know  what  the  custom  is  about  putting  all 
these  documents  into  the  record.  I  am  expressing  no  opinion  as  to  how  I  stand  on 
this  bill,  because  I  have  an  open  mind.  Personally,  I  raise  an  objection  to  putting 
these  documents  into  the  record? 

The  Chairman.  Do  you  object  to  it? 

Mr.  Johnson.  Yes,  sir. 

The  Chairman.  The  Chair  will  leave  it  to  the  committee  as  to  whether  it  shall  be 
included  in  the  record  or  not. 

Mr.  Webster.  Mr.  Chairman,  I  do  not  want  to  argue  this  matter,  but  I  think  that 
any  newspaper  extracts,  or  anything  that  sheds  any  light  on  the  matter  we  are  con- 
sidering, unless  it  unduly  burdens  the  record,  should  be  permitted  to  go  in. 

Mr.  Johnson.  That  is  the  point  I  make,  Judge  Webster.  We  have  all  read  the 
statements  of  Gen.  Dawes  as'  to  his  work  and  read  them  every  afternoon.  It  is  biu*- 
dening  the  record  to  put  these  extracts  in. 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY.  145 

Mr.  Webster.  By  way  of  amondment  to  Mr.  Johnson's  motion,  I  move  that  the 
chairman  l)e  given  authority  to  control  the  record  in  respect  to  filins:  and  makine:  a 
part  of  the  hearings  extracts  from  papers,  documents,  and  the  like;  that  it  rest  in  the 
discretion  of  the  chairman. 

The  (iHAiRMAN.   Is  the  committoo  ready  to  vote  on  that  question? 

Mr.  JoHNsnx.  T  think,  ]\rr.  Chairman,  if  W(^  do  that  we  might  as  well  give  the  chair- 
man authority  to  hold  these  hearings.  I  have  great  conlideiice  in  the  chairman,  but  I 
do  not  think  we  should  irive  him  authority  to  control  the  record,  or  to  hold  the  hearings. 
I  do  not  object  to  anything  in  Gen.  Dawes  statement.  The  very  thing  Gen.  Dawes 
complains  of  is  the  thing  we  are  doing  here.  Gen.  Dawes  complains  that  this  Govern- 
ment is  wasteful,  and  we  are  permitting  these  matters  to  go  into  the  record,  and  in 
that  way  we  are  wasteful,     ^^'hat  I  am  trying  to  do  is  to  cut  these  things  out. 

Mr.  WEB,STEr{.  Mr.  Chairman,  it  is  obvious  that  somebody  must  be  in  jmsition  to 
control  the  details  of  the  printing  of  any  hearings.  My  observation  has  Vjeen  that  it  is 
generally  done  by  the  chairman  without  any  special  authorization.  Surely  the 
committee  does  not  want  to  pass  on  every  offer  that  is  made  to  insert  excerpts  from 
newspapers  and  such  matter  in  the  record.  It  seems  to  me  to  be  proper  to  leave  the 
matter  to  the  sound  di.scretion  of  the  chairman. 

Mr.  Mapes.  Mr.  (Chairman,  I  wonder  if  the  witness  would  not  be  willing  to  withdraw 
his  reque^  for  the  insertion  of  this  in  the  record  and  avoid  any  further  discussion  of  it. 

The  Chairman.  I  do  not  think  the  whole  business  is  worth  the  time  it  takes  to 
discuss  it.  If  the  gentleman  had  seen  fit  to  state  in  his  own  way  anything  that  was  in 
this  excerpt  it  would  have  saved  all  this  time.  Now  we  have  wasted  a  number  of 
minutes  here  talking  about  the  matter. 

Mr.  Webster.  Will  the  chairman  put  my  motion? 

The  Chairman.  Mr.  Webster  moves  that  the  chairman  have  discretion  as  to  what 
matter  shall  go  into  the  record. 

(The  motion  was  put  and  prevailed.) 

The  Chairman.  I  would  say  if  anybody  came  in  here  with  a  pam])hlet,  I  would 
object.  But  I  think  we  would  save  time  but  letting  him  put  it  in,  and  save  the  time 
we  use  in  talking. 

Mr.  JtiHNsoN.  Now,  I  am  not  going  to  interrupt  again  if  he  talks  all  day,  but  my 
idea  was  that  we  are  doing  the  very  thing  that  Gen.  Dawes  said  we  ought  to  stop; 
that  it  costs  the  Government  a  lot  of  money  to  print  documents  of  that  kind,  and  Gen. 
Dawes'  statement  was  to  the  effect  that  we  ought  to  stop  the  waste,  and  that  is  the 
very  thing  I  proposed  to  do. 

The  Chairman.  The  witness  will  please  proceed. 

Mr.  Adriaans.  The  next  question  to  present  for  the  consideration  of  the  committee 
is  whether  the  bill  constitutes  an  abuse  of  the  taxing  powers  to  divert  money  so  raised 
to  the  purposes  mentioned  in  the  bill.     It  my  judgment  it  does. 

The  futility  of  the  proposed  ser^dce  is  apparent,  as  it  is  apt  to  produce  discord 
between  the  Federal  and  State  Governments,  instead  of  concord  and  cooperation. 

That  the  bill  commits  the  Federal  Government  to  the  tenets  of  socialism  and 
paternalism  is  clear  to  my  mind.  No  dereliction  of  service  by  the  States  is  suggested 
needing  national  corrective. 

The  bill  discriminates  against  the  Territories  and  the  District  of  Columbia,  denying 
its  proposed  benefits  to  the  Territories  and  the  District  of  Columbia,  notwithstanding 
the  fact  that  the  Territories  and  the  District  of  Columbia  are  under  the  exclusive 
jurisdiction  of  (Congress,  and  hence  do  not  get  this  service  except  they  get  it  from 
Congress. 

No  suggestion  is  made  that  the  States  do  not  already  furnish  the  data  mentioned 
in  the  bill  or  that  a  national  reprint  thereof  is  necessary. 

Section  6  provides  appropriations  for  lecturers,  clerks,  and  supplies,  creating  propa- 
ganda work.  It  is  obscure  how  babies  would  be  saved  or  maternity  facilitated  by 
publishing  statistics  from  States  which  are  not  even  apt  to  be  read  thereafter. 

A  State  that  does  not  match  a  Federal  appropriation  or  does  not  accept  Federal 
conditions  disqualifies  itself  thereby  from  the  proposed  benefits  of  the  act.  If  no 
State  so  appropriates,  no  State  gets  such  benefits,  notwithstanding  the  bureau  draws 
salaries  and  diminishes  the  appropiiation  meanwhile.  The  attitude  of  the  States 
should  be  first  ascertained  from  the  legislatures  and  not  its  governors. 

Section  6  conflicts  with  section  13  in  that  the  first  permits  and  the  second  disallows 
expenditures  for  rentals,  etc.     "Other  expenses,"  in  section  6  would  include  rentals. 

It  is  not  expectant  mothers  nor  unborn  babes  whom  the  act  should  benefit,  but 
doctors  who  conduct  obstetrical  operations.     Action,  not  talk,  is  essential  in  producing 
births.     No  incompetency  by  doctors  is  hinted.     Doctors  are  alert  on  this  subject. 
!•   The  bill  creates  a  vicious  precedent  in  that  it  provides  for  untoward  incidents  of 
childbirth  and  makes  no  proA-ision  for  longevity  at  subsequent  periods.     It  is  as  im- 

74654—21 10 


146  PUBLIC   PROTECTION   OF   MATERISTITY  AND   INFANCY. 

portant  to  aid  a  child  over  scarlet  fever  and  various  other  ailments  children  are  sub- 
ject to  as  it  is  to  usher  it  alive  into  the  world.  Yet  the  bill  authorizes  no  such  service. 
The  principle  of  this  bill  would  warrant  a  duplication  of  medical  service  for  every 
ailment  that  may  terminate  the  child's  life.  Each  species  of  medical  service  would 
be  entirely  independent  of  each  other  species.  We  would  have  numerous  medical 
services  each  drawing  sustenance  at  long  range  from  the  Federal  Government  without 
coordination  between  them. 

The  gestating  mothers  and  the  born  and  unborn  babes  of  the  District  of  Columbia, 
of  Alaska,  of  American  Samoa,  of  Guam,  of  Hawaii,  of  the  Panama  Canal  Zone,  of 
Porto  Rico,  of  those  enlisted  and  engaged  in  the  United  States  military  and  naval 
service  abroad,  of  the  Philippine  Islands,  of  the  Virgin  Islands  do  not  appeal  to  the 
proponents  of  this  legislation.  That  seven  children  died  of  influenza  in  one  insti- 
tution on  or  about  December,  1920,  gives  them  no  concern.  Their  eves  are  open  and 
their  ears  are  attuned  only  to  the  propsective  mothers  and  babes  within  the  boundaries 
of  the  sovereign  States.  And  their  purpose  is  to  facilitate  accouchements  by  lectures. 
In  that  connection,  Mr.  Chairman,  I  have  a  table  which  illustrates  what  I  am  now 
saying.  It  is  significant  that  the  philanthropic  purposes  of  the  proponents  of  this 
bill  and  this  legislation,  that  the  benefits  of  the  bill  are  not  intended  for  the  District 
of  Columbia,  with  its  population  of  437,571;  for  Alaska,  with  its  population  of  54,899; 
for  American  Samoa,  with  its  population  of  8,956;  for  Guam,  with  its  population  of 
13,275;  for  Hawaii,  with  its  population  of  255,912;  for  the  Panama  Canal  Zone,  with 
its  population  of  22,858;  for  Porto  Rico,  with  its  population  of  1,299,809;  for  those 
engaged  in  the  military  and  naval  service  abroad,  amounting  to  117,238;  for  the 
Philippine  Islands,  with  their  population  of  10,350,640;  for  the  Virgin  Islands,  with 
their  population  of  26,951;  making  a  total  of  12,587,209. 

I  have  here  a  clipping  taken  from  the  Evening  Star  of  December  20,  1920,  showing 
that  seven  infants  died  at  St.  Ann's  Infant  Asylum  or  hospital,  at  2300  K  Street,  in 
the  District  of  Columbia,  which  I  would  like  to  insert  in  the  record,  if  I  may. 

The  Chairman.  Your  statement  will  cover  that. 

Mr.  Adriaans.  That  the  Children's  Bureau  is  wasting  the  public's  money  at  the 
very  time  when  the  public  is  seeking  relief  from  excessive  taxation  is  apparent  by 
a  clipping  from  the  Evening  Star  of  December  20,  1920,  which  I  have  here  and  will 
put  it  into  the  record,  indicating  that  an  interstate  committee  had  been  authorized 
to  prepare  and  approve  plans  for  weighing  and  measuring  babies.  If  Congress  abol- 
ished the  entire  bureau  it  would  be  a  step  in  the  right  direction  of  administering  the 
cost  of  the  Federal  Government,  with  incidental  relief  to  the  citizens  from  unnecessary 
taxation. 

Mr.  Adriaans.  While  it  is  true  that  the  principle  of  this  bill — Federal  and  State 
cooperation — has  been  applied  on  other  subjects — and  I  have  a  clipping  here  to  that 
effect 

Mr.  Barkley  (interposing).  Are  these  statements  that  the  witness  hands  in  to  be 
published  without  action  by  the  committee? 

The  Chairman.  That  is  left,  by  action  of  the  committee,  for  the  chairman  to  decide. 

Mr.  Barkley.  I  am  willing  to  do  that. 

Mr.  Adriaans.  I  am  willing  they  shall  be  excluded,  if  they  are  not  pertinent  to 
the  question. 

May  I  continue,  Mr.  Chairman? 

The  Chairman.  Yes;  you  have  about  four  minutes  left. 

Mr.  Adriaans.  While  it  is  true  that  the  principle  of  this  bill — -Federal  and  State 
cooperation — has  been  applied  on  other  subjects,  yet  the  question  here  is  whether 
the  subject  matter  of  this  bill  is  of  such  general  importance  as  to  apply  this  principle 
thereto.  This  opponent  registers  a  negative  on  that  question.  To  test  the  matter,  if 
25  legislatures  appropriate  their  respective  quotas  to  effectuate  the  hill,  then  utiliza- 
tion of  the  appropriation  should  commence;  otherwise  not.  Moreover,  the  custody 
and  control  of  the  fund  should  be  with  the  Public  Health  Service  and  not  -with  the 
Children's  Bureau. 

The  Chairman.  Your  time  has  expired,  Mr.  Adriaans.  Does  any  gentleman  care 
to  ask  him  any  questions? 

Mr.  Newton.  Mr.  Chairman,  I  should  like  to  ask  a  question  or  two. 

The  Chairman.  Mr.  Newton. 

Mr.  Newton.  Do  I  understand  that  you  take  the  position  that  the  Congress  does 
not  have  the  power,  constitutionally,  to  pass  legislation  of  this  kind? 

Mr.  Adriaans.  I  say  the  only  source  of  the  power  would  be  found  in  the  clause 
pertaining  to  the  general  welfare. 

Mr.  Newton.  Yes:  now,  do  you  claim  that  that  clause  is  insufficient  upon  which 
to  predicate  power  of  this  kind? 

Mr.  Adriaans.  There  has,  of  course,  to  be  absolutely  a  line  of  demarcation  between 
cases  that  come  under  that  clause  and  cases  that  do  not  come  under  that  clause 


PUBLIC  PROTECTION   OF   MATERNITY  AND   INFANCY.  147 

Now.  thoro  have  boon  Bom(i  10  or  12  dociaions  of  the  IJnitod  Htatos  Supromo  Court 
constriiinK  that  clauso,  and  if  the  scntloman  wants  to  inform  himsolf  as  to  what  the 
Supromo  ('ourt  of  tho  United  States  has  deci(h>d  on  that  subj^-ct.  I  am  willing  to 
furnish  tho  fi;(>ntloman  with  the  decisions  of  the  Supremo  (,'ourt,  showint^  its  con- 
struotion  of  that  clause. 

Mr.  Ni;wT()N.  Well,  I  can  lind  out  what  th(*  decisions  of  tho  Supreme  Court  are. 
But  I  wanted  to  get  tho  gentleman's  viewfjoint  who  is  appearing  before  the  committee, 
because 

Mr.  Adriaan.s  (interposing).  In  my  mind  it  is  stretching  the  general  welfare  clause 
too  far. 

Mr.  Newton.  That  is  what  I  am  getting  at. 

Mr.  Adri.x.vn.s.  Yes:  it  goes  beyond  tho  contemplated  limits  of  those  words,  as  I 
construe  them. 

Mr.  Nkwtox.  That  is  what  I  wanted  to  get  at. 

Mr.  Ai)iu.\.\x.s.  Yes,  sir. 

Mr.  Nkwtox.  Now.  do  you  entertain  the  same  view  with  reference  to  the  Smith- 
Hughes  .Act,  for  example,  which  is  an  educational  act  pure  and  simple,  whereby  the 
Government  donates  to  tho  States,  on  its  appropriating  a  like  sum,  an  amount  of 
money  for  advancing  vocational  education? 

Mr.  Adhiaans.  Yes. 

Mr.  Newtox'.  Do  you  entertain  tho  same  views? 

Mr.  .'Vdriaans.  The  vocational  education  anfl,  in  fact,  all  species  of  education  are 
to  bo  referred  to  that  same  clause,  and  whether  a  particular  line  of  service  comes 
within  or  without  that  clauso  is  to  bo  referred,  in  the  last  analysis,  to  tho  .so.und  judg- 
ment of  ( "ongress.     I  think  there  is  danger  of  overstepping  the  bounds. 

Mr.  Newton.  Of  course,  there  is  certainly  a  danger  of  going  too  far. 

Mr.  Adriaans.  Yes:  there  is 

Mr.  Newton  (interposing).  I  wanted  to  know  whether,  in  your  judgment,  Congress 
has  gone  too  far  in  acts  like  the  Smith-Hughes  Act,  or  acts  like  the  Fess  Act.,  which 
was  passed  two  years  ago,  wherein  we  appropriated  money  to  be  matched  by  like 
sums  by  the  States  for  rehabilitation  of  those  disabled  in  industry? 

Mr.  Adriaans.  Well,  I  am  not  able  to  lay  down. offhand  a  line  of  demarcation;  I 
would  think  myself  presumptuous  to  do  it,  but  there  is  clearly  a  limitation  to  that 
power.  What  was  intended  by  the  framers  of  the  Constitution  "to  be  included  in  that 
and  what  was  intended  to  be  excluded  from  it  is  a  question  about  which  men  may 
differ. 

Mr.  Newton.  Yes;  it  is  very  hard  to  fix  that  line. 

Mr.  Adriaans.  Yes,  sir. 

Mr.  Newton.  I  agree  with  you  that  it  is  very  difficult  to  fix  that  line. 

Mr.  Adriaans.  Yes. 

Mr.  Newton.  Now,  you  quoted  from  the  case  of  South  Carolina  v.  The  United 
States. 

Mr.  Adriaans.  Yes,  sir. 

Mr.  Newton.  That  is  a  case  growing  out  of  the  fact  that  the  State  of  South  Carolina 
conferred  upon  dispensaries  or  State  agents  the  right  to  sell  liquor? 

Mr.  Adriaans.  Yes,  sir. 

Mr.  Newton.  I  want  to  call  your  attention  to  an  extract  from  that  san.e  opinion 
on  page  448  of  the  opinion,  as  follows: 

"Being  a  grant  of  powers  to  a  government,  its  language  is  general:  and  as  changes 
come  in  social  and  political  life,  it  embraces  in  its  grasp  all  new  conditions  which  are 
within  the  scope  of  the  powers  in  terms  conferred.  In  other  words,  while  tl;e  powers 
granted  do  not  change,  they  apply  from  generation  to  generation  to  all  things  tc  which 
they  are  in  their  nature  applicable." 

Jlr.  Adriaans.  Yes. 

Mr.  Newton.  It  continues: 

"This  in  no  manner  abridges  the  fact  of  its  changeless  nature  and  meaning.  Those 
things  which  are  within  its  grants  of  power,  as  those  grants  were  uuderstcod  when 
made,  are  still  Avithin  them;  and  those  things  not  within  them  remain  still  excluded." 

Y'"ou  subscribe  to  that,  of  course? 

Mr.  Adriaans.  Yes,  sir. 

Mr.  Newton.  That  is  all. 

The  Chairman.  Are  there  any  further  questions?  If  not,  we  are  very  much  obliged 
to  you,  Mr.  Adriaans. 

Mr.  Adriaans.  I  am  very  thankful  to  you,  Mr.  Chairman,  and  gentlemen  of  the 
committee,  for  your  patience  in  listening  to  me. 

The  Chairman.  Now,  gentlemen  of  the  committee,  ^^-ithout  objection,  tho  chair- 
man will  reserve  the  right  to  edit  this  testimony  to  the  extent  of  tho  matters  requested 
to  be  inserted.     The  Chair  hears  Jio  objection. 


\ 


148  PrBLIC   PEOTECTION   OE   MATEKNITY  AND   INFANCY. 

The  next  witness  is  Mrs.  Putnam.  1 

Mr.  Hawes.  Mr.  Chairman,  may  I  ask  Mr.  Adriaans  a  question?  1 

The  Chairman-.  Certainly.  "  I 

Mr.  Hawes.  You,  Mr.  Adriaans,  complain  about  this  service  being  extended  to 
the  States,  and  then,  on  the  other  hand,  you  inquire  why  it  is  not  extended  to  the 
Philippine  Islands,  Hawaii,  and  the  Virgin  Islands  and  the  District  of  Columbia. 
It  seems  to  me  there  is  a  marked  inconsistemcy. 

Mr.  Adriaans.  I  am  very  glad,  Mr.  Hawes,  that  you  called  my  attention  to  that. 
In  alluding  to  the  fact  that  these  territories  are  omitted,  I  did  not  mean  to  say  that 
it  should  be  extended  to  the  States.  I  only  meant  to  draw  attention  to  the  fact  of 
the  discrimination;  if  this  thing  is  good  for  the  States,  it  will  be  equally  good  for  the 
Territories;  and  if  the  Territories  are  to  be  excluded  from  the  benefits  of  this  act, 
by  similarity  of  logic  the  States  should  be  likewise  excluded.  My  contention  still 
is  that  there  is  an  encroachment  by  the  Federal  Government  on  the  powers  of  the 
States  in  this  legislation  and  that  it  should  not  be  applied  in  any  State  of  this  Union. 
The  Chairman.  If  that  is  all,  we  thank  you,  Mr.  Adriaans.  We  will  now  hear 
Mrs.  Putnam. 

STATEMENT  OF  MBS.  WILLIAM  LOWELL  PUTNAM,  REPRESENTING 
THE  WOMAN'S  MUNICIPAL  LEAGUE  OF  BOSTON,  MASS. 

The  Chairman.  Will  you  please  give  your  name,  and  whom  you  represent? 

Mrs.  Putnam.  My  name  is  Mrs.  William  Lowell  Putnam,  and  I  represent  the 
Woman's  Municipal  League,  of  Boston,  which  is  behind  me  in  this  matter,  and  I  also 
represent  myself .     My  home  is  in  Boston. 

I  say,  Mr.  Chairman  and  gentlemen,  I  represent  myself,  because  I,  I  think,  have  per- 
haps some  right  to  speak  on  this  matter,  as  I  made  the  initial  experiment  in  prenatal 
care  on  which  this  bill  is  founded,  and  I  should  like  to  offer  as  credentials  of  my  state- 
ment this  pamphlet  of  Dr.  J.  Whitridge  Williams.  This  pamphlet  happens  to  be  on  the 
Significance  of  Syphilis  in  Prenatal  Care  and  in  the  Causation  of  Foetal  Deaths,  but  in 
this  pamphlet  he  says  this:  "Indeed,  I  do  not  think  I  shall  go  far  wrong  when  I  state 
that  the  greatest  credit  in  this  respect  belongs  to  Mrs.  William  Lowell  Putnam,  who 
some  years  ago  organized  at  her  own  expense  in  Boston  a  small  service  in  which  women 
could  be  supervised  during  pregnancy  for  the  purpose  of  instruction  in  the  rudiments 
of  the  hygiene  of  pregnancy." 

I  have  also  a  letter  by  a  Avell-known  obstetrician  of  Boston,  who  is  connected  with 
the  Boston  lying-in  hospital,  in  answer  to  a  letter  published  in  the  Medical  Journal,  by 
Dr.  Oppenheimer,  of  the  Children's  Bureau.  I  regret  I  have  not  Dr.  Oppenheimer's 
letter  here .  She  was  advocating  the  bill,  and  her  letter  was  in  answer  to  a  letter  of  mine 
which  the  Medical  Journal  published,  of  which  I  have  a  reprint  here.  In  her  letter 
she  said  that  the  reason  I  opposed  the  bill  was  because  I  did  not  understand  the  con- 
ditions. So  Dr.  Huntington  wrote:  "Her  charge  that  Mrs.  Putnam's  objection  is 
based  on  insufficient  knowledge  is  perfectly  ridiculous.  The  point  is  that  Mrs.  Put- 
nam, who  has  taught  the  world  the  value  of  the  prenatal  nurse,  knows  that  a  division 
of  hygiene  composed  largely  of  pediatricians  is  not  equipped  for  the  job  of  teaching  the 
United  States  of  America  better  obstetrics." 

I  am  sorry  I  have  to  speak  of  these  things  in  my  own  behalf;  it  sounds  a  little  obnox- 
ious, but  otherwise  you  might  not  know  that  I  was  qualified  to  speak. 

Now,  I  have  two  objections  to  this  bill.  In  the  first  place,  I  doubt  very  much  its 
legality.  The  police  power  of  the  several  States  has  never  been  given  over  by  them 
to  the  Federal  Government.  Of  course,  the  public  health  is  a  part  of  the  police 
power,  excepting  in  matters  of  quarantine  for  either  foreign  or  domestic  affairs,  it  is  a 
matter  for  the  State  jurisdiction  for  it  concerns  the  State  alone.  When  it  is  interstate 
matter,  as  in  the  case  of  contagious  diseases,  it  is  under  the  Federal  control. 

No  one  can  suggest  that  pregnancy  is  a  contagious  malady.'  Sometimes,  with  the 
diminishing  population,  I  wish  it  were. 

I  should  like  to  mention  in  this  connection,  that  I  myself  have  had  five  children;  T 
have  eight  grandchildren,  the  oldest  one  being  5,  so  there  is  no  race  suicide  in  my 
family. 

I  do  not  mind  in  the  least  being  interrupted  at  any  moment  with  any  question,  so  if 
anyone  wants  to  interrupt  me,  I  should  be  glad  to  have  him  do  so. 

A  great  many  other  bills  and  laws  have  been  mention.ed  to  prove  that  such  legis- 
lation ie  correct.  For  instance,  the  good  roads  law  is  mentioned,  and  the  child  labor 
law,  and  the  law  with  reference  to  venereal  diseases,  etc.;  but  they  involve  an 
entirely  different  principle.  In  the  good  roads  law,  for  instance,  the  roads  to  be  of 
use  must  go  on,  regardless  of  State  boundaries,  and,  of  course,  the  primary  reason  for 
the  enactment  of  such  a  law  is  that  there  shall  be  good  roads  in  case  of  war  for  the 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  149 

transportation  of  troops  and  Hupplios,  and  thorjtore  they  must  go  from  one  State  to 
another  across  the  roiuitry. 

In  regard  to  child  labor,  that  is  a  matter  in  which  th";  Federal  Government  must 
come  to  tlie  help  of  the  State  government,  and  it  is  a  subject  with  which  the  State 
government  can  not  deal  with  alone  williout  putting  the  States  which  have  good  child 
labor  laws  at  the  mercy  of  those  which  hav<;  not.  Tlu;  only  [jnjtection  lor  the  States 
is  in  having  such  laws  uniform. 

The  matter  of  the  control  of  venereal  diseasee,  of  course,  comes  under  the  head  of 
contag'ion. 

I  think  it  will  Ix-  found  that  all  other  legislation  follows  the  same  general  lines. 

Of  course,  tlie  Smith-Towner  bill  db3s  not,  and  therefore  it  meets  with  exactly  the 
same  objection  as  this  l)ill. 

Mr.  Newton.  May  I  ask  you  a  (|uesti(m  there? 

Mis.  Putnam.  Certainly. 

Mr.  Nkwton.  Do  you  entertain  the  same  views  with  reference  to  the  Smith-Hughes 
Act,  foi  example? 

Mrs.  PuTN.-vM.  I  am  sorry  to  say  that  I  am  not  familiar  with  the  Smith-Hughes  Act 
and  so  I  can  not  answer  that  question. 

Mr.  Nrwton.  My  lecoUection  of  the  Smith-Hughes  Act  is  that  the  Federal  Gov3rn- 
ment  api)ropriates  a  certain  amount  of  money  each  year;  it  is  allotted  to  the  several 
States  according  to  population,  providing  that  that  State  sets  apart  for  the  same  pur- 
pose at  least  a  like  sum  of  money,  to  be  used  for  the  furthering  of  vocational  education. 

Mrs.  Putnam.  I  have  no  doubt  your  statement  is  perfectly  correct,  but  I  could  not 
express  an  opinion  without  reading  the  act  and  studying  it  very  carefully. 

Mr.  Newton.  Then,  there  is  what  is  known  as  the  Fess  Act,  wherein  the  Federal 
Government  appropriates  money  to  the  vaiious  States  according  to  population,  pro- 
viding that  the  States  appropriate  at  least  a  like  sum,  and  those  appropriations  are 
to  be  used  for  the  rehabilitation  of  men  or  women  who  have  become  diseased  in 
industry. 

Mrs.  Putnam.  That  is  in  the  same  situation.  I  am  sorry  to  say  I  am  not  familiar 
with  those  acts,  and  therefore  I  can  not  express  an  opinion. 

The  whole  idea  of  legislation  of  this  sort,  however,  is  to  favor  paternalism,  and  if  a 
country  becomes  paternalistic,  ine\itably  the  virility  of  the  population  is  destroyed. 

Now,  supposing,  however,  that  I  am  wrong,  and  that  there  should  be  such  legisla- 
tion, then  the  question  arises  as  to  the  Children's  Bureau  being  the  proper  place  for 
the  administration  of  this  act.  And  in  that  connection,  I  think  we  might  study  some 
ot  the  statements  made  by  some  of  the  proponents  of  this  bill.  Dr.  Baker,  Dr.  Van  Ingei', 
Dr.  Potter,  and  Dr.  Foote,  the fourdoctoiswho were puton the  stand  by  the  proponents 
of  the  bill.  Those  four  doctors  who  were  put  forward  by  the  proponents  of  the  bill 
all  admitted  that  medical  care  was  necessary;  they  all  admitted  that  every  woman 
should  see  a  doctor  during  her  pregnancy,  if  possible. 

Possibility  has  no  application  here,  because  if  it  is  not  possible,  of  course,  she  can 
not  do  it,  so  we  might  as  well  omit  those  two  words.  They  should  see  a  doctor;  every 
medical  person  testifying  agreed  to  that.  Now,  that  is  a  very  striking  agi'eement, 
so  much  so,  that  it  was  absolutely  unavailing. 

There  is  a  good  deal  of  distinction  which  should  be  made  here,  in  all  the  testimony 
which  has  been  given  by  the  proponents  of  the  bill.  In  all  this  testimony,  there  has 
been  a  confusion  between  child  hygiene  and  maternity  care.  The  two  are  not  synony- 
mous. The  statements  of  Dr.  Baker  and  the  others  were  largely  concerned  with 
I  child  hygiene,  and  in  all  of  those  statements,  they  dwelt  greatly  on  the  educational 
j  feature.  The  educational  feature  is  really  the  principal  thing  needed  in  child  hygiene, 
[because  there  is  no  reason,  if  a  child  is  born  right — I  am  taking  child  hygiene  now  as 
I  coming  after  the  lirst  month  of  life — if  a  child  is  born  right  and  started  right  and  taken 
I  proper  care  of,  there  is  no  reason  why  it  should  ever  need  medical  care.  Medical 
information  can  be  given  through  books  which  are  written  on  the  subject  by  qualitied 
physicians,  and  through  their  training  given  to  nurses  and  filtered  down  tlu'ough  the 
nm'ses  to  the  patients.  Medical  care  is  absolutely  unnecessary  in  that  case,  unless 
the  child  becomes  ill. 

This  is  not  true  of  maternity  care.  Maternity  inevitably  involves  danger.  I 
must  speak  somewhat  frankly  on  these  subjects,  else  I  can  not  make  myself  clear. 
Pregnancy  is  almost  always  accompanied — indeed  it  is  apt  to  be  one  of  the  first  symp- 
toms which  convinces  a  woman  that  she  is  pregnant — by  nausea  in  the  morning, 
commonly  called  morning  sickness.  That  is  a  form  of  toxaemia,  undoubtedly.  A 
perfectly  normal  woman  probably  would  not  have  that  nausea  at  all.  But  normal 
unfortunately,  is  an  entirely  different  thing  from  usual;  and  there  are  comparatively 
few  people  who  are  completely  normal.  That  morning  sickness,  which  is  thought 
little  or  nothing  of,  is  undoubtedly  a  form  of  toxaemia.    The  exact  reason  for  it  has 


150  PUBLIC  PROTECTION    OF   MATERNITY  AND   INFANCY. 

not  yet  been  discovered,  but  it  is  unquestionably  due  to  something  in  the  foetal 
circulation,  which  has  poisonous  effect  upon  the  mother,  and  sometimes  if  this  nausea 
is  allowed  to  continue  unchecked,  it  may  result  in  pernicious  vomiting,  which  is  a 
very  dangerous  thing. 

Another  form  of  toxaemia,  which  is  the  most  dangerous  of  all,  is  commonly  called 
convulsions,  which  is  the  common  name  for  eclampsia;  that  is  the  most  serious  danger 
of  pregnancy. 

And  if  you  noticed  the  statistics  which  have  been  given  you,  some  of  which  were 
reliable,  though  some  were  not,  the  number  of  deaths  from  piierperal  septicemia 
(that  is  an  infection  usually  acquired  from  dirty  attendants  at  the  birth),  have  been 
reduced,  but  the  deaths  from  albuminuria  or  eclampsia,  which  occm's  most  conunonly 
dining  pregnancy  have  not  been  reduced;  they  have  rather  been  increased. 

There  is  no  question  that  something  is  needed  for  the  protection  of  the  pregnant 
woman.     The  question  is  what  is  needed?     Is  this  bill  going  to  furnish  it? 

Now,  I  have  just  mentioned  that  Dr.  Williams  had  kindly  given  me  the  credit  for 
starting  this  work.  Dr.  Williams  has  been  quoted  often  in  the  hearings  here  as  being 
opposed  to  this  bill.  Let  me  read  you  a  few  lines  of  what  he  says  in  the  only  testimony 
which  he  gave  that  would  indicate  his  mind,  which  was  the  testimony  referred  to  by 
the  proponents. 

The  Chairman.  Just  let  me  interrupt  you.  Do  you  refer  to  Dr.  Williams,  of 
Baltimore? 

Mrs.  Putnam.  Dr.  J.  Whitridge  Williams,  of  Baltimore. 

The  Chairman.  You  just  said  that  he  had  been  referred  to  as  opposing  this  bill; 
you  mean  he  has  been  referred  to  as  favoring  the  bill? 

Mrs.  Putnam.  The  proponents  said  that  he  was  in  favor  of  it. 

The  Chairman.  You  just  said  that  he  was  quoted  as  being  opposed  to  it. 

Mrs.  Putnam.  I  beg  yoiu-  pardon;  it  was  a  slip  of  the  tongue.  I  should  have  said 
that  he  has  been  quoted  as  being  in  favor  of  it.  He  spoke  at  one  hearing  with  the 
propenents  of  this  bill,  and  this  is  what  he  said.  It  was  in  the  Sixty-sixth  Congress, 
at  their  session,  last  year,  last  December,  1920. 

Mr.  Newton.  In  the  House  or  in  the  Senate? 

Mrs.  Putnam.  In  the  Senate  hearing.  [Reading.]  "I  am  not  altogether  prepared 
to  express  an  opinion  concerning  the  exact  details  of  the  bill,  but  I  should  be  glad  to 
say  a  few  words  on  the  need  for  similar  aid  along  the  lines  of  the  bill." 

That  is  the  nearest  approach  of  Dr.  Williams  toward  favoring  the  bill . 

The  Chairman.  I  might  make  another  interruption:  The  reason  I  mentioned  that 
was  to  state  that  there  is  a  letter  on  file  here,  which  will  be  introduced  and  referred 
to  in  the  report,  from  Dr.  Williams,  dated  the  12th  day  of  July,  in  which  he  says  flatly 
that  he  is  opposed  to  the  bill. 

Mrs.  Putnam.  He  has  written  me  one  or  two  letters  to  the  same  effect. 

The  Chairman.  If  there  is  any  desire  for  the  letter  now  we  will  have  it  brought  in 
at  this  moment. 

Mrs.  Putnam.  Now,  education  is  much  dwelt  on  in  this  bill.  Now,  as  I  said,  you 
can  educate  in  child  hygiene;  you  can  very  wisely  educate  the  mother  in  this.  But 
can  you  educate  her  in  maternity  care  ?  What  can  you  do  ?  You  can  teach  the  mother 
exactly  one  thing:  Who,  what  kind,  and  what  quality  of  physician  she  should  call  in, 
and  that  is  all  you  can  do,  except  to  tell  her  to  drink  a  certain  amount  of  water,  and  to 
rest,  and  to  eat  a  certain  amount  of  wholesome  food,  and  to  be  reasonable  in  every- 
thing she  does.  And  it  takes  just  about  the  length  of  time  I  have  taken  to  tell  it,  and 
that  is  all. 

You  can  not  instruct  an  expectant  mother  how  to  overcome  pelvic  abnormalities, 
prevent  postpartum  hemorrhage,  to  prevent  infection  at  the  hands  of  poorly  trained 
nurses,  midwives,  and  physicians,  to  emerge  alive  from  an  attack  of  pneumonia  or 
typhoid  fever  occurring  at  certain  stages  of  pregnancy  or  to  prevent  the  toll  of  maternal 
deaths  shortly  after  childbirth  in  the  case  of  tuberculous  women.  These  are  some  of 
the  great  dangers.  You  can  not  take  care  of  these  by  education;  no  education  of  the 
mother  can  overcome  them. 

I  feel  like  quoting  from  the  Book  of  Job,  where  the  Lord  answered  Job  out  of  the 
whirlwind,  and  said,  "Who  is  this  that  darkens th  counsel  by  words  without  knowl- 
edge?" 

I  want  to  quote  a  little  from  the  bill,  because  it  has  been  talked  about  a  great  deal 
here,  and,  naturally  it  is  the  important  thing  we  have  to  study,  it  is  a  singularly 
loosely  drawn  bill.  It  does  not  seem  to  me  to  mean  anything  in  some  spots;  at  least, 
I  can  not  understand  what  it  means.  Now,  for  instance,  in  the  very  first  paragraph 
it  says — I  have  here  the  corrected  Senate  copy^with  the  Senate  amendments: 

"That  there  is  hereby  authorized  to  be  appropriated  annually,  out  of  any  money  in 
the  Treasury  not  otherwise  appropriated,  the  sums  authorized  in  section  2  of  this  act, 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY,  151 

to  be  paid  to  the  several  States  for  the  purpose  of  cooperating  with  the  States  in  pro- 
moting the  care  of  maternity  and  infancy  in  the  several  States;  to  provide  instruction 
in  the  hygiene  of  maternity  and  infancy." 

Does  it  mean  what  it  says,  that  this  money  is  paid  to  the  States  for  "the  purpose  of" 
cooperating  with  them,  or  is  it  paid  to  encourage  and  enal)le  them  to  do  the  work? 

Section  2  says: 

"That  for  the  pur|)OKe  of  paying  the  expenses  of  said  cooperative  work  in  providing 
the  services  and  facilities  specified  in  this  act."  What  are  the  expenses  of  said  co- 
operative work?     Does  it  mean  the  work  of  the  Government,  or  the  Htates,  or  what? 

Then,  again,  here  is  a  result  that  is  very  interseting:  The  ])ill  ap})roi)riates  the  sum 
of  $480,000  for  each  year,  $10,000  of  which  shall  be  paid  annually  tf)  each  State,  in 
the  manner  provided  in  the  bill.  Did  you  know  that  the  State  of  Minnesota  had 
already  passed  a  law,  through  its  legi'^lature,  that  it  would  accept  this  .|10,000? 

Mr.  Newton.  That  is  my  own  State;  it  has. 

Mrs.  Putnam.  I  had  it  from  the  health  oificer  direct,  so  1  also  knew  it.  In  accepting 
this  money  the  State  d<»es  not  have  to  appropriate  any  itself;  it  has  a  right  to  have  this 
$10,000  outright  and  spend  it  as  it  chooses.  I  do  not  know  whether  this  was  contem- 
plated by  the  ))ill  or  not. 

Again,  with  reference  to  the  advisory  committee: 

"The  chief  of  the  Children's  Bureau,  as  executive  officer,  is  hereby  authorized  to 
form  an  advisory  committee  to  consult  with  the  chief  of  the  Children's  Bureau  and  to 
advise  concerning  any  problems  which  may  arise  in  connection  with  the  carrying  out 
of  the  provisions  of  this  act." 

Though  the  appointment  of  this  advisory  committee  be  made  mandatory  it  amounts 
to  nothing;  it  can  not  consult  with  the  States.  But  with  the  chief  of  the  Children's 
Bureau.  It  is  easier  to  give  advice  than  to  have  it  taken.  I  think  the  younger  gen- 
eration have  taught  us  that.  Advice  is  free,  l)ut  the  chief  of  the  Children's  Bureau 
is  under  no  compulsion  to  take  it. 

"The  Children's  Bureau  shall  have  charge  of  all  matters  concerning  the  administra- 
tion of  this  act," — that  has  not  been  generally  quoted.  It  is  in  section  3  of  the 
act.- — "and  shall  have  power  to  cooperate  with  the  State  agencies  authorized  to  carry 
out  the  provisions  of  this  act.  It  shall  be  the  duty  of  the  Children's  Bureau  to  make 
or  cause  to  he  made  such  studies,  investigations,  and  report&as  will  promote  the  efficient 
administration  of  this  act." 

That  seems  to  give  it  a  good  deal  of  power  to  put  its  finger  into  the  States. 

Now,  of  course,  we  have  been  told  that  this  is  a  woman's  measure.  Here  it  comes 
out: 

"The  Children's  Bureau  may  recommend  to  the  Ste,te  agencies  cooperating  under 
this  act  the  appointment  of  advisory  committees,  both  State  and  local,  to  assist  in 
carr^dng  out  the  purposes  of  this  act;  the  members  of  such  advisory  committees  shall 
be  selected  by  the  State  agencies,  and  at  least  half  of  such  members  shall  be  women, 
all  of  the  members  of  which  advisory  committee  shall  serve  without  compensation." 

I  think  myself  that  the  men  are  as  much  interested  as  the  women  in  this  act.  So 
it  goes  on.  I  will  not  bother  you  by  reading  it  all.  It  seems  to  me  it  is  difficult  to 
understant,  in  spots,  what  it  does  mean. 

But  in  section  8  it  is  perfectly  clear: 

"That  any  State  desiring  to  avail  itself  of  the  benefits  of  this  act  shall,  by  its  agency 
described  in  section  4,  submit  to  the  Children's  Bureau  for  its  approval  detailed  plans 
for  carrying  out  the  provisions  of  this  act.  These  plans  shall  include  the  provisions 
to  be  made  in  the  State  for  the  administration  of  the  act;  the  provision  for  instruction 
in  the  hygiene  of  maternity  and  infancy  through  public-health  nurses,  consultation 
centers,  and  other  suitable  methods." 

Now,  Dr.  llumiston,  when  he  was  speaking  here,  made  a  little  slip.  He  said  that 
the  Children's  Bureau  was  to  make  the  rules  to  which  the  States  must  subscribe. 
There  is  no  such  provision  in  the  bill,  but  for  practical  purposes  it-is  the  same  thing; 
they  have  a  right  to  ]jass  on  the  plans  made  by  every  State. 

There  is  a  very  interesting  thing  here  in  section  9.  Each  State  is  allowed,  by 
section  4,  to  create  a  State  agency,  and  under  section  9  ' '  the  State  agency  described 
in  section  4  is  authorized  to  arrange  with  any  educational  institution  for  the  provision 
oi  extension  courses  by  qualified  lecturers"  on  the  subject  of  hygiene  of  infancy  and 
maternity  and  related  subjects.  Who  shall  decide  what  lecturers  are  qualified  and 
what  they  are  qualitied  to  do?  The  section  continues:  "'Provided,  That  not  more 
than  25  per  centum  of  the  sums  granted  by  the  United  States  to  a  State  under  this 
act  shall  be  used  for  this  purpose." 

Twenty-five  per  cent  of  all  that  money,  averaging  more  than  $20,000  for  each  State, 
a  total  of  8250,000,  may  go  to  people  who  are  qualified,  nobody  knows  by  whom,  to 
talk  on  these  subjects.     It  seems  to  me  that  is  a  very  great  waste  of  money;  an  awful 


152  PUBLIC  PEOTECTION   OF  MATERNITY  AND  INFANCY. 

waste  of  money,  and  with  dangerous  possibilities.  The  speakers  from  the  Children's 
Bureau  to  do  this  talking  are  to  be  nontechnical,  i.  e.,  nonmedical  speakers. 

Sec.  11.  "That  the  Children's  Bureau  shall  every  three  months  ascertain  the 
amounts  expended  by  the  several  State  agencies  described  in  section  4  in  the  pre- 
ceding quarter  year." 

I  suppose  this  means  expenditures  of  the  funds  provided  by  this  bill.  Does  it  mean 
expenditures  of  their  own  money,  as  well  as  Federal  money?  It  seems  to  say  so.  It 
says,  "the  amoimts  expended."  It  seems  to  me  that  is  interfering  with  Ihe  States 
quite  heavily. 

Then  again:  "The  Children's  Bureau  may  withhold  the  allotment  of  moneys  to 
any  State  whenever  it  shall  be  determined  that  such  moneys  are  not  being  expended 
for  the  purposes  and  under  the  conditions  of  this  act.  If  any  such  allotment  is  with- 
held from  any  State,  the  State  agency  of  such  State  may  appeal  to  the  Secretary  of 
Labor,  and  if  the  Secretary  of  Labor  shall  not  direct  such  sums  to  be  paid  it  shall  be 
covered  into  the  Treasury  of  the  United  States." 

There  is  no  appeal  to  the  courts  permitted  under  this  act. 

Again:  "No  portion  of  any  moneys  apportioned  under  this  act  for  the  benefit  of 
the  States  shall  be  applied,  directly  or  indirectly,  to  the  purchase,  erection,  preserva- 
tion, or  repair  of  any  building  or  buildings  or  equipment,  or  for  the  purchase  or  rental 
of  any  buildings  or  lands."  Now,  the  one  thing  that  is  most  needed  in  the  rural 
districts  for  maternity  care  is  good  hospitals.  This  bill  absolutely  forbids  the  use  of 
money  for  hospitals. 

There  is  an  amendment  pending  in  the  Senate,  by  Senator  Kenyon,  to  insert  a 
provision  that  the  chief  of  the  Children's  Bureau  shall  be  responsible  to  the  Secretary 
of  Labor.     So  much  for  the  bill. 

It  gives  very  broad,  very  loosely-written  powers  to  the  bureau  to  interfere  in  the 
actions  of  the  State,  a  thing  which  seems  to  me  unfortunate. 

It  is  all  very  well  to  say  there  is  no  compulsion  on  the  part  of  any  State  to  accept 
this  money.  Take  the  State  of  New  York,  for  instance.  Under  the  good  roads  bill 
the  State  of  New  York  is  obliged  to  appropriate  $9,000  to  every  $1,000  which  it  received 
back  again.  Was  there  any  compulsion  to  a,ccept  that  $1,000?  No;  but  there  is  an 
absolute  compulsion  to  pay  the  $9,000.  Excuse  my  language,  but  that  lack  of  com- 
pulsion talk  is  "tommyrot." 

Now,  in  making  the  State  boards  of  health  responsible  to  the  head  of  the  Children's 
Bureau — and  I  do  not  want  to  be  thought  for  one  moment,  in  anything  I  say,  to  be 
casting  aspersions  on  anybody  at  all — my  remarks  are  addressed  to  the  provisions  of 
the  bill,  regardless  of  the  individual  who  may  at  any  particular  time  administer  them. 
I  must  say  a  few  things  in  connection  with  the  bill,  but  they  are  not  personal.  We 
are  putting  those  medical  staffs  of  the  State  boards  of  health  under  the  Children's 
Bureau,  and  I  do  not  believe  there  is  a  single  State  board  of  health,  although  there 
are  local  ones,  that  are  not  administered  by  physicians.  I  hope  there  is  not.  By  the 
way,  it  is  an  amusing  little  episode,  that  there  is  a  great  deal  of  credit  being  taken  for 
the  rapid  development  of  the  divisions  of  child  hygiene  in  the  State  boards  of  health. 
I  was  president  of  the  American  Child  Hygiene  Association  four  years  ago,  the  year 
of  the  war,  and  I  devoted  considerable  energy  myself  to  encouraging  State  boards  of 
health  to  form  divisions  of  child  hygiene.  Of  course,  I  do  not  know  whether  I  accom- 
plished anything,  but  I  tried. 

It  might  interest  you,  possibly,  to  know  in  this  connection  that  I  am  running  now 
a  prenatal  and  obstetrical  clinic  in  Boston.  By  the  courtesy  of  the  newest  hospital 
there,  the  Peter  Burt  Brigham  Hospital — the  hospital  that  sent  one  of  the  two  first 
medical  units  to  France  after  we  entered  the  war,  one  of  the  most  modern  hospitals 
there  is  anywhere — we  are  kindly  permitted  the  use  of  two  rooms  in  the  out-patient 
department  of  the  hospital  for  the  use  of  our  clinic,  the  hospital  taking  no  responsi- 
bility whatever  for  it.  I  am  conducting  it,  with  the  help  of  the  younger  men  of  the  staff 
of  the  Boston  Lying-in  Hospital,  and  the  women  who  come  there  are  given  the  best 
obstetrical  care. 

It  has  been  said  with  truth,  as  far  as  large  cities  are  concerned,  that  the  poor  get  the 
best  care  in  childbirth  because  they  go  to  the  best  hospitals;  the  rich  get  it  if  they 
know  enough;  but  the  great  middle  class,  the  backbone  of  the  country,  seldom  have 
the  care  they  ought  to  have.  So  I  am  running  this  clinic  to  prove  that  the  very  best 
obstetrical  care  can  be  given  by  the  best  obstetricians  and  nurses  on  a  self-supporting 
basis  for  a  price  which  people  of  moderate  means  can  afford  to  pay,  and  when  I  have 
completed  my  experiment,  I  think  it. will  go  over  the  civilized  world,  as  the  prenatal 
care  which  I  told  you  I  had  started  has  done.  My  correspondents  in  regard  to  pre- 
natal care  range  from  Edinburgh  to  New  Zealand,  and  cover  this  country  and  Canada,, 
and  scarcely  a  week  passes  that  I  do  not  get  letters  asking  for  the  reports  which  tell 
how  it  was  carried  on.  It  has  always  been  given  under  medical  supervision.  No 
nurse  is  allowed  to  take  any  responsibility  except  under  the  doctor's  orders. 


PUBLIC   PROTECTION    OF    MATERNITY   AND    1^M•'ANC;Y.  153 

Now,  with  the  j)os9il)ility  of  passin<i;  this  hill  and  jjiittiiis:  tho  adminiHtratioii  of  the 
act  undor  the  Children's  Bureau,  you  are  ])u1linL,'  tlie  nie(liciil  ])rofe.s.sion  in  exaetl\' 
the  position  in  which  you  would  ])ut  the  niodical  staff  of  a  ,t,'n!at  hos))ital  if  you  ])ut 
them  \mder  the  staff  of  social  service  workers  of  the  hospital.  Could  you  Vet  any 
good  doctors  in  that  hospital  if  that  w(u-e  the  law?  I  doubt  it.  The;  social  service 
worker  in  medical  matters  has  exactly  the  same  relation  to  a  doctor  that  the  nurse  has. 
They  are  both  his  assistants.  The  oliject  of  the  social  service  medical  worker  is  to 
help  the  doctor.  You  know  that  social  service  work  in  hospitals  was  started  in  I 'oston 
hy  Dr.  Richard  Cabot,  at  the  Massachusetts  (rcneral  Hospital,  because  he  found  that 
unless  he  knew  the  home  conditions  of  his  patients  he  was  unable  to  ])reseribe  for 
them  wisely.  That  has  been  found  Irue  in  many  ways.  In  a  school  for  mothers  in 
London  they  had  classes  for  the  mothers  in  cookinji:,  and  the  mothers  used  to  come  in 
and  take  great  interest  in  learning  how  to  cook  at  the  institution.  One  day,  in  order 
to  see  how  it  worked  out  in  the  homes,  they  sent  a  worker  to  see  whether  the  condi- 
tions were  any  better  than  before.  When  the  worker  visited  the  homes,  ,she  found  the 
women  cooking  in  the  same  old  way,  and  the  reason  they  did  it  in  the  same  way  was 
that  one  had  only  a  s])i(ler  to  cook  with,  another  perhaps  a  coffee  pot,  and  they  did  not 
have  intelligence  enough  to  adapt  the  information  they  had  l)een  given  to  the  meager 
sup]dy  of  utensils  in  their  homes.  Then  Ihe  school  began  to  send  the  teacher  around 
to  the  honu's  to  show  the  women  how  to  adapt  what  they  had  been  taught  to  their 
own  conditions  with  such  success  that  the  children  called  this  teacher  the  "])udding 
lady." 

Now,  that  is  the  same  condition  that  confronts  the  doctor.  He  must  know  the 
conditions  in  the  home  that  the  man  or  woman  or  child  must  meet.  There  is  no  usse 
to  prescribe  terrapin  when  they  can  not  possil  )ly  buy  it.  I  am  using  that  as  an  extreme 
illustration.  The  social  worker  is  a  valuable  assistant  to  the  doctor,  but  in  no  way 
can  she  supersede  him  and  the  medical  care  which  has  got  to  be  given  must  begin 
at  the  top  if  you  are  going  to  have  it  properly  carried  out  below. 

Now,  I  want  to  forestall  a  little  statement  which  may  be  made  in  the  rebuttal, 
because  it  has  l)een  made  to  me.  And  that  is,  that  this  bill  would  be  administered 
by  the  doctors  of  the  Children's  T'ureau.  There  is  nothing  in  the  bill  whatever  to 
call  for  anything  of  the  sort,  nor  could  the  chief  in  any  way  abrogate  her  responsibility 
if  she  did  put  it  under  them,  because  the  bill  puts  it  definitely  and  distinctly  under 
her.  The  Secretary  of  Labor  by  the  latest  amendment  shares  her  responsil)ility, 
but  two  negatives  do  not  make  an  affirmative.  The  Secretary  of  Labor  and  the  chief 
of  the  Children 's  lUu'eau  do  not  together  make  a  medical  person. 

The  l)ill  calls  now  for  a  sum  which  is  evidently  only  the  beginning,  because  it 
could  not  possil)ly  be  administered  to  do  much  good  with  the  small  sum  called  for. 

As  an  example — and  please  rememl^er  again  that  there  is  nothing  personal  in  this— 
I  have  the  first  annual  report  of  the  ('hildren's  Bureau.  It  was  originally  given 
$25,000,  with  the  understanding  that  that  was  to  be  its  annual  stipend.  With  that 
$25,000  and  a  staff  of  15  they  did  good  work  that  first  year,  but  this  first  report  in  its 
closing  paragraph,  after  submitting  a  plan,  says: 

'"In  accordance  with  this  plan,  an  increase  of  the  staff  for  1915  to  76  persons — " 

It  began  work  in  .\ugust,  1912,  so  its  annual  report  was  not  issued  for  the  fiscal  yeai , 
till  June,  1913,  and  was  not  printed  until  1914. 
"is  requested,  and  an  appropriation  for  salaries  and  expenses  of  ?164,640." 

Five  times  the  number  of  people  who  had  worked  the  first  year  and  worked  well; 
and  six  and  a  half  times  the  appropriation. 

Economy  as  well  as  efficiency  would  call  for  the  administration  of  all  health  matters 
by  one  body.  There  was  a  smile  just  now  when  Mr.  Adrien  said  that  if  this  bill  was 
pas.sed  it  would  be  necessary  to  have  other  powers  for  other  health  matters.  Of  course, 
he  meant  if  they  were  going  to  carry  this  thing  out  logically. 

I  feel,  myself,  that  the  important  place  to  begin  is  with  prenatal  care.  That  is  the 
mo.st  important  thing.  I  believe  in  beginning  at  the  beginning  logically.  If  you  do 
that  you  are  going  to  begin  at  the  right  place,  and  then  \'ou  can  go  on  logically  to  the 
end.  P>ut  the  ])ill  provides  for  putting  the  administration  of  this  act  into  the  Chil- 
dren's Bin-eau.  If  you  do  that  and  proceed  logically  you  are  going  to  multiply  enor- 
mously all  overhead  charges — for  the  (  hildren's  Bureau  obviously  can  not  take  care 
of  all  health  matters  in  the  community;  you  are  going  to  have  an  overhead  expense 
that  will  he  very  large,  and  a  separate  one  for  each  phase  of  health  woi'k.  Moreover, 
you  are  not  going  to  do  it  as  efficiently. 

I  have  been  \-er>'  much  interested  in  this  sort  of  thing  for  a  great  many  years,  so 
that  I  have  made  a  point  of  studying  it.  For  my  personal  pleasure  I  take  two  medical 
journals  a  week  and  two  health  journals  monthly,  to  say  nothing  of  my  own  State  and 
city  health  reports.  Louisiana  and  other  States  also  send  me  their  reports,  so  I  have  an 
idea  of  what  is  going  on  throughout  the  country.  And  for  years  I  took  the  Public 
Health  reports.     So  please  bear  in  mind  that  I  am  not  speaking  without  knowledge. 


154  PUBLIC  PROTECTION"   OF  MATERNITY  AND  INFANCY. 

Economy  and  efficiency  necessitate  the  management  of  all  Federal-  health  matters 
V)y  one  board.  AVe  have  no  right  to  spend  the  people's  money  on  fads,  and  it  is  not 
only  a  fad  but  a  dangerous  one  to  have  the  Children's  Bureau  administer  the  care  of 
maternity  and  infanc>\ 

It  is  absurd  to  think  women  can  do  it  better  than  men.  The  most  successful 
women's  journal  in  the  country,  the  ladies'  Home  Journal,  was  edited  by  Mr.  Bok. 
He  met  the  wants  of  the  women  of  the  country  for  a  home  journal,  and  he  niade  an 
overwhelming  success  of  that  paper;  and  yet  he  was  a  bachelor.  It  is  suggested  that 
he  is  not  a  bachelor  now,  but  he  was  at  the  time  he  started  this  paper.  I  have  just 
been  reading  his  life.  In  the  normal  relations  of  life,  the  sexes  are  naturally  attracted 
to  each  other,  and  each  sex  has  the  most  influence  over  its  opposite.  That  is  a  thing 
we  are  apt  to  overlook  sometimes  in  propaganda  work,  but  it  is  true,  and  you  all 
know  it. 

One  speaker  said,  I  think  Dr.  Baker,  that  the  Public  Health  Service  has  not  taken 
up  the  work  of  the  care  of  children.  That  shows  an  inexcusable  ignorance  of  the 
facts  of  the  case.  Anybody  who  does  this  kind  of  work  ought  to  know  the  facts — then 
such  a  statement  would  be  impossible.  As  I  told  you,  I  hold  no  brief  for  the  Public 
Health  Service  or  the  medical  profession  in  general.  I  think  some  of  them  just  as 
stupid  as  the  most  of  us,  but  I  do  know  what  I  am  saying,  because  I  haVe  studied  this 
naatter.  The  Public  Health  Service  has  done  an  enormous  amount  of  work  for  chil- 
dren. I  wish  you  all  would  read  the  last  annual  report.  It  will  give  you  an  immense 
amount  of  useful  information.  Some  of  you  are  old  enough  to  remember  the  scourge 
of  yellow  fever,  how  we  used  to  tremble  even  in  the  North  lest  it  be  brought  up  here, 
and  how  the  Southern  States  suffered  fearful  ravages,  and  how  Dr.  Walter  Reed 
pacrified  his  life  to  prove  what  he  believed  to  be  true,  that  it  was  conveyed  by  the  bite 
of  a  mosquito;  and  how  they  set  about  eradicating  the  mosquito,  till  now  there  is  no 
yellow  fever;  or  none  to  amount  to  anything;  if  a  little  outbreak  begins  it  is  imme- 
diately stopped.  The  same  is  true  of  malaria;  they  have  made  studies  and  have 
experimented,  until  they  have  practically  eradicated  malaria. 

Mr.  Towner.  Doctor,  I  understood  you 

Mrs.  Putnam  (interposing).  I  am  not  a  doctor. 

Mr.  Towner.  I  beg  your  pardon.  Mrs.  Putna^m,  will  you  please  state  again  what 
you  stated  was  said  about  the  Public  Health  Service,  and  by  whom? 

Mrs.  Putnam.  I  don't  quite  understand  you. 

Mr.  Towner.  You  are  basjng  this  statement  that  you  make  now  upon  some  sort 
of  statement  you  said  was  very  foolish  and  which  was  untrue;  a  statement  made  by 
somebody  that  testified  here. 

Mrs.  Putnam.  Mr.  Chairman,  is  it  quite  correct  to  answer  questions  from  outsiders? 

The  Chairman  .  It  is  hardly  in  order,  but  we  want  the  facts,  and  if  it  is  not  extended 
we  will  allow  it. 

Mrs.  Putnam.  What  was  it  you  wanted? 

Mr.  Towner.  You  are  basing  this  statement  you  make  upon  some  sort  of  a  state- 
ment that  you  said  was  very  foolish  and  was  untrue,  which  was  made  by  somebody 
that  testified  here. 

Mrs.  Putnam.  I  said  the  statement  was  made  that  the  Public  Health  Service  had 
not  taken  up  the  care  of  children. 

Mr.  Towner.  By  whom? 

Mrs.  Putnam.  By  one  of  the  witnesses;  I  think  it  was  Dr.  Baker. 

Mr.  Towner.  In  this  hearing? 

Mrs.  Putnam.  In  this  hearing.     I  ask  that  that  may  be  verified,  Mr.  Chairman. 

The  Chairman.  You  are  simply  giving  the  best  of  your  recollection? 

Mrs.  Putnam.  No;  I  wrote  it  down  at  the  time,  because  I  was  so  struck  by  it. 

Mr.  Towner.  What  was  it  that  was  stated? 

Mrs.  Putnam.  That  the  Public  Health  Service  had  not  taken  up  the  care  of  chil- 
dren. I  am  not  going  at  length  into  the  work  of  the  Public  Health  Service.  The 
Public  Health  Service  officials  are  here.  It  is  not  necessary  forme  to  go  into  it. 
They  can  speak  for  themselves.  But  I  should  like  to  say  that  their  first  publication 
on  the  care  of  children  was  published  in  1902.  That  was  on  the  management  of  out- 
breaks of  scarlet  fever  and  diphtheria.  The  Children's  Bureau  was  not  formed  till 
1912,  and  according  to  the  official  list  of  its  publications  its  first  pamphlet  other  than 
its  annual  report  was  not  published  until  1914. 

I  have  here  a  list  of  the  more  recent  publications  of  the  Public  Health  Service. 
In  1908  and  the  Immediately  succeeding  years  they  published  manymost  valuable 
pamphlets  on  the  subject  of  milk.  I  used  to  make  a  great  study  of  milk.  For  eight 
years  I  tried  to  get  a  clean-milk  bill  through  the  Legislature  of  Massachusetts  and 
only  desisted  when  I  found  that  the  worst  adulterant  of  milk  was  politics.  For  my 
sins  I  was  obliged  to — and  I  have  a  mania  for  thoroughness  when  I  undertake  a  thing — • 
I  was  obliged  to  and  did  read  all  the  bulletins  published  by  the  Public  Health  Serv- 


PUBLIC  PROTECTION   OF   MATERNITY   AND   INFANCY.  155 

ice  on  milk.  The  largest  publication  was  a  coinj)ilation  on  "Milk  in  its  Relation  to 
Public  Ilealtli."  it  is  a  volume  about  so  thick  [iiidicatinf^],  of  000  or  700  paf^es,  an 
extremely  valuable  ])ook.  Of  course  this  was  not  done  for  grown  people.  This  was 
done  for  babies  and  little  children.  There  is  not  so  much  danger  from  dirty  milk 
for  adults;  of  course  they  may  die  from  se])tic  sore  throat  or  contract  tyyjhoid  fever 
or  some  other  disease,  l)ut  the  danger  is  not  so  great.  The  real  danger  from  dirty 
milk  comes  when  it  is  given  to  babies.  So  all  these  publications  were  especially  for 
the  benefit  of  the  children. 

In  1910  they  wrote  a  history,  ])a8ed  on  investigations,  of  that  most  dangerous  and 
fatal  disease,  infantile  pari  lysis.  In  1911  and  1912  they  compiled  the  municipal 
ordinances  and  regulations  concerning  birtli  registration.  We  have  heard  a  great  deal 
of  what  tlie  Children's  Bu'reau  has  done  toward  getting  proper  birtli  registration.  If 
we  did  not  know  these  facts,  we  might  think  they  were  the  only  ones.     They  were  not. 

The  Public.  Uealth  Service  also  published  data  regarding  the  operations  of  infants' 
milk  stations.  And  in  1913  they  published  a  very  valuable  little  treatise  on  The  Care 
of  the  Bal)y,  prepared  Ijy  the  American  Hygiene  Association.  According  to  the  report 
of  the  list  of  Children's  Ihireau  publications,  their  first  publication  dealing  with  chil- 
dren was  puljlishcd  in  ]914.  T  have  here  a  list  of  the  recent  publications  of  the  Public 
Health  Service  on  the  care  of  children,  but  I  will  not  trouble  you  to  read  it  all. 

So  much  for  the  work  of  the  Public  Health  Service  on  the  care  of  children.  I 
think  it  is  rather  convincing. 

Now,  another  thing.  During  the  war  no  one  can  question  that  the  Red  Cross  was, 
in  medical  matters,  very  well  administered.  The  medical  head  was  a  very  able  man. 
When  he  wanted  some  readable  little  pamphlets  on  the  care  of  children  for  the  in- 
struction of  mothers — I  have  got  some  of  them  right  here — did  he  go  to  the  Children's 
Bureau?  No.  He  went  to  the  Public  Health  Service,  who  prepared  the  pamphlets 
for  him,  and  there  they  are,  with,  the  Red  Cross  on  them.  I  have  only  Motherhood 
and  Bottle  Feeding  for  Babies,  but  they  had  one  also  on  Breast  Feeding  Her  Baby, 
which  was  ven,-  important.  I  have  that  in  a  subsequent  edition,  got  out  since  the 
war  without  the  Red  Cross.  They  are  in  this  form.  [Exhibiting  pamphlets.]  I 
brought  several  of  them  with  me.     I  have  here  several  copies. 

The  Chairman.  You  might  leave  them  with  the  clerk  of  the  committee.  Do  you 
desire  these  to  be  published? 

Mrs.  Putnam.  Just  as  the  committee  sees  fit. 

The  Chairman.  The  clerk  of  the  committee  will  make  a  reference  to  each  one  of 
these  documents  and  give  it  to  the  reporter  to  be  embodied  in  the  report 

(The  list  of  such  publications,  so  referred  to,  is  printed  in  full,  as  follows:) 

Motherhood,  by  the  United  States  Public  Health  Serviee,  for  distribution  by  the 
American  Red  Cross. 

Bottle  Feeding  for  Babies,  by  the  United  States  Public  Health  Ser\ice,  for  distri- 
bution by  the  American  Red  Cross. 

Motherhood.  Keep  Well  Series  No.  8.  Treasury  Department,  United  States 
Public  Health  Service,  1919. 

Breast  Feeding  Her  Baby.  (Exactly  like  the  one  in  the  Keep  Well  series;  if  none 
was  given  the  committee  it  was  because  they  had  given  out.) 

Breast  Feeding  Her  Baby.  The  Baby's  "Right.  The  Mother's  Privilege.  Keep 
Well  Series  No.  9.  Treasury  Department,  United  States  Public  Health  Service. 
1919. 

Bottle  Feeding  for  Babies.  Keep  Well  Series  No.  10.  Treasury  Department, 
United  States  Public  Health  Service.     1919. 

United  States  Public  Health  Service,  Rupert  Blue,  Surgeon  General.  The  Care  of 
the  Baby.  Supplement  No.  10  to  the  Public  Health  Reports.  December  19,  1913. 
(Edition  of  March,  1917.) 

^Irs.  Putnam.  I  have  some  of  the  pamphlets  here. 

The  Chairman.  You  may  leave  those,  if  you  wish. 

Mrs.  Putnam.  Since  the' time  I  have  spoken  of  they  have  published  a  bulletin 
with  reference  to  the  summer  care  of  infants  and  one  on  malnutrition  in  children,  etc. 

Now,  it  is  rather  interesting  to  note  that  I  saw  a  clipping  the  other  day— if  you 
want  to  get  things  you  have  to  subscribe  to  a  clipping  bureau.  I  saw  in  a  clipping 
the  other  dav  that  this  spring  the  Florida  State  Department  of  Health  and  the  State 
Federation  of  Women's  Clubs— I  hesitate  to  sav  how  many  women  there  were  in 
the  State  federation,  but  I  think  about  150,000;  t  know  it  was  a  large  number— were 
so  impressed  with,  the  need  of  child  care  in  Florida  that  they  sent  the  president  of 
the  federated  clubs  and  the  State  health  officer  to  Washington  to  ask  the  help  of  the 
Public  Health  Ser\'ice  in  starting  child  hvgiene  work  in  Florida.  And  this  goes  to 
prove  two  things— first,  that  the  Federation  of  Women's  Clubs  are  not  all  behind  this 
bill,  as  you  have  been  told;  second,  how  much  work  the  Public  Health  Service  does 


156  PUBLIC   PKOTECTIOlSr   OF   MATERNITY   AND   INFANCY, 

in  child  hygiene  to  help  the  States,  for  this  is  not  the  first  time  that  the  Public  Health 
Service  has  been  called  on  for  such  help  by  the  States,  and  many,  many  times  they^ 
have  been  asked  and  have  given  it. 

When  I  mentioned  that  I  was  opposing  this  bill,  I  was  asked  if  I  did  not  want  to 
save  mothers  and  babies.  Do  you  think  I  spent  five  years  on  an  experiment  in  pre- 
natal care — and  I  have  a  few  of  my  own  pamphlets  here,  by  the  way,  if  you  want 
them — in  which  I  proved  the  value  completely;  do  you  think  I  should  have  spent 
five  years  on  that  experiment  if  I  had  not  wanted  to  save  the  mothers  and  the  babies? 
In  our  work  we  reduced  the  premature  births  to  seven-tenths  of  1  per  cent  and  we  cut 
the  still  births  more  than  in  two  and  we  never  lost  a  mother  in  all  the  1,500  pregnancies 
we  cared  for.     But,  remember,  this  was  always  under  medical  supervision. 

The  Chairman.  In  what  territory  is  that? 

Mrs.  Putnam.  That  is  in  Boston.  It  was  always  under  medical  supervision.  The 
nurse  was  not  even  permitted  to  strap  a  patient's  back  without  the  doctor's  approval. 

Mr.  Newton.  Was  this  a  saving  over  the  whole  area  of  Boston,  or  some  section  of 
it?     I  am  trying  to  get  at  a  general  idea  of  the  extent  of  the  work. 

Mrs.  Putnam.  It  is  more  or  less  a  cross  section.  It  is  hard  to  get  such  work  started. 
It  was  begun  in  1909,  and  as  it  is  always  hard  to  get  a  start,  we  had  to  take  our  patients 
where  we  could  get  them  to  begin  with.  We  started  giving  prenatal  care  therefore  to 
the  house  patients  of  the  Boston  lying-in  hospital,  and  later  we  took  the  patients  of 
the  Massachusetts  Homeopathic  Hospital  and  certain  patients  for  private  physicians. 

You  remember  Dr.  Baker  spoke  of  a  paper  she  read  at  the  baby-saving  show  in 
Philadelphia.  I  also  read  a  paper  there,  and  Dr.  Van  Ingen,  who  testified  here, 
opened  the  discussion  on  my  paper — saying  that  he  was  about  to  take  up  such  work  in 
New  York,  founding  it  on  ours.  1  proved  to  my  own  satisfaction  that  the  nurses' 
visits  should  be  made  as  often  as  every  10  days,  and  as  much  oftener  as  necessary, 
according  to  the  condition  of  the  mother. 

You  might  be  interested  in  knowing  how  much  that  five-year  experiment  cost.  I 
have  a  respect  for  money;  I  think  it  is  of  quite  a  good  deal  of  use,  and  I  do  not  like  to 
waste  it.  The  whole  five-year  experiment  cost  between  $6,000  and  $7,000  only;  not 
that  much  annually,  but  for  the  whole  five  years. 

I  do  not  like  tliis  bill,  because  I  think  it  is  a  very  unkind  bill.  I  think  it  is  a  ter- 
ribly unkind  bill,  for  it  is  leading  the  mothers  of  the  country  to  believe  that  they  are 
going  to  get  protection,  which  this  bill  can  never  furnish.  If  I  thought,  as  many  doc- 
tors do,  that  it  would  not  save  a  single  life,  I  should  not  mind  it  so  much,  because  then 
it  would  fall  of  its  own  weight,  and  not  do  much  harm,  but  I  believe  it  will  save  a 
small  percentage  of  the  lives  that  might  be  saved  by  a  proper  bill,  and  this  percentage 
though  small  will  be  considerable  in  number ;  the  numbers  will  be  heralded  throughout 
the  country,  the  people  say,  "See  what  a  wonderful  thing  this  is,"  and  they  will  rest 
there,  so  that  the  90  per  cent,  as  I  believe,  who  might  be  saved  by  a  proper  measure 
now,  will  go  on  for  years  dying,  and  what  is  worse,  living  as  invalids,  because  when  a 
community  is  once  satisfied,  it  is  very  hard  to  rouse  it  again.  Therefore,  because  I 
want  to  save  the  mothers  and  babies  I  want  the  bill  as  at  present  drawn  to  be  defeated. 

Mr.  HuDDLESTON.  May  I  ask  why  it  will  not  save  a  larger  percentage? 

Mrs.  Putnam.  Because  you  can  not  save  them  without  medical  care.  Take  the 
statement  of  the  labor  union  man,  Mi-.  Grady,  about  the  woman  in  the  Tennessee 
mountains  who  was  in  labor  10  or  12  or  more  hours,  and  the  doctor  finally  arrived 
there  to  find  mother  and  baby  both  dead .  Mi-.  Grady  thought  the  doctor  said  that  their 
deaths  were  due  to  malnutrition,  but  it  could  not  have  been  due  to  malnutrition. 
Malnutrition,  on  the  contrary,  would  have  made  the  delivery  easier.  A  half  pound 
difference  in  a  baby's  weight  often  may  mean  life  or  death  to  the  mother.  It  was  due 
to  a  contracted  pelvis  which  could  not  be  guarded  against  without  medical  care. 

Mr.  HuDDLESTON.  May  I  ask,  whether  you  have  any  measures  to  suggest  other  than 
those  contemplated  in  this  bill? 

Mrs.  Putnam.  To  put  it  in  the  hands  of  the  Public  Health  Service. 

Mr.  HuDDLESTON.  Oh,  that  is  what  you  mean? 

Mrs.  Putnam.  That  is  what  I  am  begging  for. 

Mr.  HuDDLESTON.  I  did  not  understand  that. 

Mrs.  Putnam.  No;  because  I  have  not  yet  said  so. 

Mr.  Newton.  You  figure  that  the  difference  in  the  administration  between  the 
Childi-en's  Bureau  and  the  Public  Health  Service  would  make  a  difference  in  the  10 
per  cent 

Mrs.  Putnam  (interposing).  Yes;  and  the  100  per  cent  who  might  be  saved.  I  said 
this  bill  would  save  only  about  10  per  cent  of  those  who  might  be  saved. 

Mr.  HuDDLESTON.  Do  you  think  that  change  will  be  brought  about  by  putting  the 
jurisdiction  in  the  Public  Health  Service  instead  of  in  the  Children's  Bureau? 

Mrs.  Putnam.  I  think  it  would. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  157 

Mr.  lIuDDLESTON.  Would  you  favor  (his  hill  if  it  wiis  ])roi)0,-ie(l  (o  ])ut  it  umlcr  lh(! 
Public  IFoalth  Service? 

Mrs.  Putnam.  Yes;  if  it  wah  worded  .so  that  ii  was  iulclliufihie. 

Mr.  IIuDDLESTON.  If  the  work  was  put  iu  char^'c  of  llio  Public  ifcalth  Service  you 
would  favor  the  bill? 

Mrs.  Putnam.  Yes;  I  should. 

Mr.  TIunoLKSToN.  Do  you  mean  you  would  f:i\nr  ihe  terms  of  the  bill  or  the  pur- 
pose of  the  bill? 

Mrs.  Putnam.  The  ])ur])oses  of  the  bill.  I  should  not  want  to  .say  1  .should  favor  it 
entirely  until  it  had  been  carefully  rewritten.  May  I  say  oiut  thiuf"::  Mr.  Ifawes 
asked,  1  think,  alioul  the  terms  of  the  bill  beinj,^  carefully  and  fully  and  exactly 
settled.  You  cau  not  settle  such  a  law  absolutely  once  and  for  all,  because  you  have 
to  <>ive  flexibility  to  it.  You  can  not  lay  down  a  hard  and  fast  rule,  because  a  lot  of 
improvements  in  the  care  <,dven  will  be  possil)le  all  the  lime,  and  you  have  Rot  to  have 
such  a  law  cai)able  of  change,  and  in  order  to  have  it  so  you  must  have  the  administra- 
tion of  it  in  (he  hands  of  one  on  whose;  jud,<?ment  you  can  rely. 

Mr.  Johnson.  I  have  been  much  enli.ii;htened,  Mrs.  Putnam,  l)y  your  statement, 
more  so  than  by  any  other  witness  that  has  appeared  here.  What  particular  part  of 
this  bill  do  you  object  to? 

Mrs.  Putnam.  Tlie  administration  of  i(  under  the  Children's  Bureau.  That  is  the 
crux  of  the  whole  matter.  1  can  not  say  that  I  approve  all  of  the  rest  of  it.  It  would 
have  to  be  carefully  j^one  over. 

Mr.  Deni.son.  You  thiuk  the  Public  Health  Service  is  the  place  to  put  it? 

Mrs.  Putnam.  Absolutely.  Another  reason  why  I  think  so  is  that  maternity  can 
not  be  separated  from  other  matters  of  health.  There  is  no  use  in  giving  the  mother 
and  child  the  most  perfect  maternity  care  if  they  are  infected  with  hookworm.  You 
will  never  turn  out  a  good  result  in  maternity  care  if  the  mother  has  malaria  or  any  of 
these  other  diseases,  or  if  she  is  drinldng  impure  water.  You  have  got  to  have  a  clean 
water  supply,  proper  sanitation  and  protection  from  other  diseases,  and  that  can  only 
be  done  through  a  unified  health  service.  There  is  no  use  in  talking  of  cooperation. 
We  have  seen  enough  of  cooperation.  ,  The  Public  Health  Service  is  being  blamed  now 
for  things  because  of  cooperation,  and  because  when  they  asked  Congress  for  a  certain 
amount  for  hospitals  for  the  soldiers,  they  were  given,  I  tliink.  about  a  third  of  what 
they  asked  for.  and  then  they  are  blamed  for  not  doing  the  job.  I  was  in  charge  of 
the  work  of  helping  the  soldiers  and  sailors  of  Massachusetts  during  the  war,  and  still 
am  serving  uncler  the  adjutant  general.  I  know  the  conditions  were  very  bad,  but 
I  do  not  blame  the  Public  Health  Service  for  the  badness,  because  they  never  had 
the  furids  or  proper  control  of  the  situation.  The  work  must  be  unified,  both  for  the 
sake  of  efficiency  and  for  the  sake  of  economy. 

Mr.  Lea.  Is  your  objection  in  reference  to  that  based  on  the  idea  that  the  work  to 
be  performed  is  medical  rather  than  sociological? 

Mrs.  Putnam.  Absolutely. 

Mr.  Lea.  How  is  that? 

Mrs.  Putnam.  Sociological  only  as  the  social-service  work  in  the  hospitals  is  socio- 
logical. 

Mr.  Lea.  So  you  believe  the  work  is  to  find  out  the  people  who  need  medical 
treatment,  and  provide  a  way  of  applying  it? 

^Irs.  Putnam.  Absolutely;  any  good  public-health  doctor,  any  good  physician, 
would  leave  no  stone  unturned  to  provide  for  the  physical  needs  as  well  as  the  medical 
needs  of  his  patient.  Y^ou  can  trust  to  the  Public  Health  Service  to  see  that  those 
social  features  are  attended  to.  They  are  so  insignificant,  compared  with  the  medical; 
and  I  will  tell  you  why  I  say  that.  It  is  not  a  mere  arlntrary  statement;  it  is  because 
I  know,  in  the  first  place,  that  with  all  the  improvement  in  child  hygiene,  with  all 
the  reduction  of  infant  mortality,  there  has  been  no  reduction  in  the  deaths  during  first 
month  of  life — rather  the  contrary.  Deaths  in  the  first  month  of  life  are  due  to  pre- 
natal causes  or  to  difficulties  at  l)irth.  In  1918  the  latest  figures  I  have  been  al)le  to 
s:et  wdth  certainty  from  the  Census  Bureau,  the  death  rate  in  the  first  month  was 
44.2  per  cent  of  the  death  rate  in  the  first  year  of  infant  life.  In  1919,  which  was  the 
last  census,  as  nearly  as  I  have  been  able  to  compute,  it  was  44.7  per  cent.  That  is, 
almost  half  of  the  mortality  during  the  (irst  year  of  life  occurs  in  the  first  month. 

Ivast  ^\'inter  the  Massachusetts  Legislature  had  a  hill  for  maternity  care  under 
consideration.  There  was  a  recess  committee  appointed  for  the  summer  by  the 
go^^ernor  to  investigate.  At  the  head  of  it  was  the  president  of  the  Massachusetts 
Medical  Society.  It  made  an  exhaustive  investigation,  and  proved  exactly  what 
was  proved  by  an  earlier  investigation  in  Detroit  made  by  Mr.  Bradley,  under  the 
Thom])son  fund.  They  proved  that  the  maternal  deaths  were  absolutely  scattered 
throughout  the  community.  They  bore  no  relation  to  the  financial  condition  of  the 
mothei's.     It  was  purely  ignorance  of  proper  prenatal  and  obstetrical  care. 


I 


158  PUBLIC   PKOTECTION   OF   MATERNITY  AND   INFANCY. 

Mr.  Lea.  Mrs.  Putnam,  from  what  I  have  heard  here,  there  seem  to  be  two  classes 
who  need  this  care.     One  is  pregnant  women,  for  instance 

Mrs.  Putnam.  Everybody  needs  it,  every  pregnant  woman  needs  it. 

Mr.  Lea.  Yes;  but  of  those  who  are  not  receiving  it  one  is  the  pregnant  mother 
who  may  be  amply  provided  with  funds  to  provide  herself  with  this  care  and  yet  is 
unconscious  of  the  need  of  it? 

Mrs.  Putnam.  Yes. 

Mr.  Lea.  So  that  accounts  for  the  death  or  ill  results  that  come  in  the  home  of 
prosperity. 

Mrs.  Putnam.  Yes. 

Mr.  Lea.  And  the  other  one  is  the  poor  class  who  are  unable  to  provide  it,  even 
though  they  are  conscious  of  the  need  of  providing  it.     Is  not  that  true? 

Mrs.  Putnam.  There  is  a  third  class,  and  that  is  those  who  would  provide  it  if 
they  could  get  it  but  live  too  remote  from  it  to  be  able  to  get  it. 

Mr.  Lea.  Now,  as  to  the  woman  who  is  capable  and  able  to  provide  this  service 
for  herself,  what  would  you  suggest  that  the  Government  do  as  to  her? 

Mrs.  Putnam.  What  would  I  suggest? 

Mr.  Lea.  As  to  the  woman  who  is  amply  provided  with  funds  to  take  care  of  her- 
self? Suppose  there  is  a  man  down  here  who  is  worth  $20,000  and  yet  his  wife  is  not 
provided  with  these  things.  What  should  the  Government  do  with  that  character 
of  woman? 

Mrs.  Putnam.  I  think  the  Public  Health  Service  should  furnish  certain  informa- 
tion on  the  subject,  and  have  it  circulated  through  the  community,  either  by  lectures 
or  by  literature. 

Mr.  Lea.  Circulated  generally  in  the  hope  that  this  particular  woman  may  get  the 
information? 

Mrs.  Putnam.  Of  course,  you  can  not  make  anything  foolproof,  you  know.  I 
mean,  you  can  not  force  people  either  to  read  or  to  go  to  lectures  or  to  be  instructed. 
All  you  can  do  is  to  try  to  reach  them.  That  is  what  I  mean  by  saying  you  can  not 
make  it  foolproof.  There  are  some  people  who  simply  do  not  believe  it,  and  do  not 
care,  and  think  that  as  long  as  their  mothers  bore  them,  perhaps  in  spite  of  the  assist- 
ance of  a  dirty  midwife  or  a  clean  midwife,  whichever  it  may  have  been,  and  got 
along  all  right,  therefore  there  is  no  danger  in  midwives.  You  might  say  that  the 
bubonic  plague  was  no  danger  in  China  because  some  of  the  population  still  live. 
There  are  people  in  that  way  that  you  could  not  reach,  but  I  think  the  Public  Health 
Service  has  as  good  facitilites  for  reaching  them  as  the  Children's  Bureau. 

Mr.  Lea.  Suppose  that  the  authorities  made  a  pregnant  woman  report  to  the  Public 
Health  Service  so  that  they  could  get  in  contact  with  the  women  who  actually  needs 
it? 

Mrs.  Putnam.  How  are  you  going  to  force  them  to  report? 

Mr.  Lea.  Of  course  that  would  be  by  law  or  regulation. 

Mrs.  Putnam.  You  can  not  force  a  pregnant  woman  to  report  her  pregnancy. 
Nobody  knows  she  is  pregnant  but  herself. 

Mr.  Lea.  Do  you  think  we  could  not  make  such  a  regulation  as  that  in  order  to  get 
in  contact  with  the  woman  who  needs  it? 

Mrs.  Putnam.  If  that  regulation  reached  the  woman,  she  might  give  the  informa- 
tion, but  I  think  you  would  do  more  harm  than  good,  and  I  should  be  very  loath  to 
have  that  regulation  passed.  You  could  not  enforce  it.  They  have  tried  it  with 
women  in  industry,  where  women  are  required  to  be  laid  off  a  certain  length  of  time 
before  childbirth.  You  can  not  make  them  report,  so  that  they  shall  be  laid  off, 
because  they  do  not  want  to  lose  their  wages.  Neither  they  nor  anyone  else  can 
always  make  a  certain  diagnosis  of  preg'nancy  until  several  months  have  passed. 

Mr.  Lea.  I  am  not  advocating  that;  I  simply  want  to  get  your  views. 

Mrs.  Putnam.  That  is  not  a  feasible  proposition,  as  I  see  it.  I  meant  to  answer 
your  question.     I  hope  I  did. 

Mr.  Lea.  You  did;  yes. 

Mrs.  Putnam.  Now,  there  is  a  great  deal  of  difference  between  education  and  care — 
prenatal  education  and  prenatal  care.  Prenatal  education  you  might  perhaps  give 
by  lectures  and  books  and  information.  Prenatal  care  never  can  be  given  in  that 
way,  and  prenatal  care  is  the  essential  thing. 

As  an  example  of  the  proof  of  the  absolute  necessity  for  this  care  being  administered 
medically,  I  have  some  very  interesting  figures  here  from  Dr.  Polak  in  Brooklyn,  at 
the  Brooklyn  Lying-in  Hospital.  This  is  a  personal  letter  to  me,  under  date  of 
June  16,1921.     He  says: 

"It  might  interest  you  to  know  what  is  being  done  in  prenatal  work  for  babies  in 
Brooklyn.  In  1,000  consecutive  cases  where  prenatal  work  under  careful  medical 
supervision,  including  a  routine  Wassermann,  was  done  in  connection  with  this 


PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY  Y.  159 

hospital,  there  were  25  infant  dciath.s,  inr-huling  the  prematures  and  those  dying 
within  the  first  two  weeks  after  liirth;  compared  with  1,000  r-ases  under  prenatal 
nursing,  supervision  only,  watched  for  us  bv  the  Nurs.-s'  A.ssociation  in  which  there 
were  47  deatlis;  and  compared  with  1.000  cases  in  which  there  was  no  prenatal  care' 
in  winch  there  were  70  infant  deaths. 

"  I  think  such  figures  as  these  are  the  strongest  evidence  of  the  necessity  of  medical 
supervision  in  all  prenatal  work." 

Of  the  babies  whose  mothers  were  given  prenatal  care,  under  nursing  supervision 
-  only,  little  more  than  50  jxt  cent  were  saved  as  compared  with  the  ones  where  medical 
8upf^r\d3ion  was  given  over  the  nursing  visits.  That  is  very  significant,  because  this 
I  bill  seems  to  advocate  nursing  supervi.sion  only. 

As  I  said,  that  labor  man  s  story  was  very  sad.  but  no  amount  of  nursing  supervision 
•could  have  guarderl  against  it.  One  of  the  things  that  medical  supervision  of  the 
pregnant  woman  does  is  to  guard  against  that  very  thing.  In  our  clinic,  for  instance, 
that  we  have  in  Boston  the  patient  must  come  twice  to  the  clinic.  She' may  come  as 
often  as  she  likes,  but  she  must  come,  first,  to  have  pelvic  measurements"  taken  in 
order  to  find  out  how  large  the  space  is  between  the  bones,  and,  second,  to  keep  track 
of  the  growth  of  the  child  in  the  womb.  It  is  essential  to  know  whether  the  child  is 
going  to  be  able  to  get  out  normally  through  that  space.  If  the  child  can  not  get  out 
normally,  the  mother  and  child  both  die  unless  they  have  skilled  medical  care."  That 
is  exactly  what  hai)pened  in  the  Tennessee  mountains  and  whv  I  said  that  it  was 
not  due  to  malnutrition. 

Mr.  Denison.  How  long  before  the  birth  of  the  cnild  is  that  done? 
'  Mrs.  TxiTNAM.  The  first  measurement  is  taken  early  in  pregnancy;  the  second 
toward  the  end  of  it.  It  is  important  that  women  should  have  i)renatal  care  just  as 
early  in  pregnancy  as  they  can  be  persuaded  to  come.  In  mv  own  prenatal  work 
I  have  one  very  strikins  ease  of  a  little  fellow  whose  mother  came  to  us. the  first  time 
only  about  two  months  before  her  baby  was  born.  She  had  a  contracted  pelvi-,  and 
the  baby  had  to  be  delivered  by  a  high  forceps  operation.  The  baby  died  of  cerebral 
hemorrhage  a  week  after  birth,  leaving  a  broken-hearted  mother.  1  he  next  time  she 
came  to  us  as  soon  as  she  knew  she  -was  pregnant  and  was  under  our  care  for  eight 
months.  She  was  delivered  by  a  Oajsarean  section,  and  the  child  was  a  fine  little 
fellow,  weighing  7  pounds  6  ounces.  We  thought  she  had  learned  her  lesson,  but 
not  at  all.  In  the  third  pregnancy  she  believed  her  neighbors,  who  told  her  it  was 
not  necessary  to  report  until  the  sixth  month,  and  she  miscarried  at  five  months. 
The  fourth  time  she  came  back  to  us  early  for  care,  and  that  time  she  had  a  fine  little 
eirl.     It  was  a  striking  case  and  is  a  good  proof  of  my  point. 

We  are  told  that  the  women  are  solidly  behind  this  bill.     I  should  like  to  read  a 
letter  that  came  to  me  unsolicited  from  a  woman  in  Pannsvlvania  after  the  appear- 
ant^e  of  my  letter  in  the  Medical  Journal.     I  do  not  think  I  will  read  the  end  of  it 
because  it  is  not  very  kind  to  the  originators  of  the  bill ' 

Mr.  Denison.  I  am  very  much  interseted  in  what  you  have  to  say.  Were  those 
measurements  that  you  speak  of  made  by  a  physician  or  a  nurse? 

Mrs  PuTXAM.  Never  by  a  nurse.  A  nurse  is  unfitted  to  do  such  a  job  and  never 
should  touch  It— should  never  meddle  with  it  al  all.  I  am  glad  you  brouo-ht  that 
3Ut.     I  should  have  brought  it  out  myself. 

This  letter  begins: 

"My  De.\r  Madam:  I  would  like  you  to  know  how  much  I  enjoyed  your  letter  in 
the  Journal  of  the  American  Medical  Association  on  the  Sheppard-Towner  bill.  As 
1  doctor's  wife  I  always  look  over  the  magazine,  and  all  the  bills  nassed  or  pending 
which  concern  the  profession  are  of  personal  interest  to  me. 

"If  the  average  woman's  club  was  anywav  representative  of  women  at  lar^^e  they 
would  not  be  so  irritating  when  they  get  off  that  yell  about  the  '  women  solidly  behind 
-IS.  In  a  small  way  here  I've  been  puncturing  their  balloon  of  pretensions.  Your 
Jtatements  of  the  fallacy  of  the  contention  should  have  sreat  weight,  and  I  hope  you 
.vill  carry  on  the  good  work. 

"It  seems  to  me  that  all  the  legislation  nowadays  tends  to  paternalism  and  away 
rom  our  system  of  local  government.  There  must  be  a  beginning  to  combat  the  evil, 
ind  1  hope  your  letter  will  start  doctors  thinking  more  seriously  of  the  evils  confront- 
ng  then-  work." 

I  will  submit  the  letter,  but  the  end  of  it  is  not  very  polite  to  some  of  the  people 
10  I  do  not  want  to  read  that.  ' 

The  Chairman-.  That  paragraph  may  be  edited,  if  the  committee  does  not  object 

Mr  Newton.  You  think  that  the  sentiment  in  favor  of  the  bill  is  not  so  much 
or  all  its  details  but  for  the  general  principle?     Do  you  not  think  that  is  true? 

Mrs.  Putnam.  I  have  no  doubt  of  it,  because  I  know  how  it  was  tried  on  me 
*Vhen  I  said  something  to  a  woman  against  the  bill,  she  said,  "Why,  don't  you  want 


160  PUBLIC   PKOTECTION    OF   MATERNITY  AND   INFANCY. 

to  save  the  mothers  and  babies?"  I  said,  "Yes;  that  is  why  I  am  opposed  to  the 
bill."  You  will  find,  if  you  ask,  most  people — I  do  not  mean  the  people  at  the  hear 
ing,  but  the  average  person  who  supports  this  bill  and  writes  to  his  £!ongressman  or 
her  Congressman  about  it  has  never  read  it.  They  only  know  that  they  have 
been  told  that  it  is  a  bill  that  will  save  mothers  and  babies. 

Mr.  Newton.  They  are  for  the  general  principle? 

Mrs.  Putnam.  Absolutely;  and  it  is  only  the  general  principle  they  are  indorsing 
Moreover,  they  only  comprise  a  small  percentage  of  the  women  of  the  country.  I 
believe  the  proponents  of  the  bill  claim  something  like  10,000,000.  I  do  not  know, 
but  it  seems  a  littla  large  to  me.  I  can  not  quite  believe  it,  especially  since  I  know 
that  this  large  body  of  Federated  Clubs  is  not  solidly  in  favor  of  this  bill.  Yet  even 
if  they  are,  as  there  are  51,000,000  women  and  over  in  the  country,  the  10,000,000 
they  are  said  to  claim  would  be  only  a  fifth  of  them.  They  have  been  sajdng  that 
the  bill  was  four-fifths  social  and  economic  and  only  one-fifth  medical.  It  seems 
to  me  that  a  fifth  is  a  mystic  number  to  the  proponents  of  the  bill.  It  reminds  me 
of  the  old  conundrum,  "If  you  call  a  dog's  tail  his  leg,  how  many  legs  will  he  have?  " 
He  "will  have  four,  because  calling  a  tail  a  leg  does  not  make  it  so.  Neither  does 
calling  the  bill  four-fifths  social  and  economic  make  it  so. 

Now,  I  want  to  say  one  thing,  and  then  I  am  going  to  stop.  This  is  a  man'?  affair 
exactly  as  much  as  a  woman's.  But  men  have  been  at  a  great  disadvantage  when 
women  come  and  talk  to  them  about  this  bill,  for  naturally  a  layman  does  not  know 
about  the  medical  features  of  childbearing,  and  he  thinks  that  women  must  know 
because  they  bear  the  children.  It  does  not  seem  to  occur  to  the  men  that  the 
women  do  not  know  either.  If  anybody  were  to  say  to  any  of  you,  "You  digest 
three  meals  a  day,  do  you  not?  Do  you  think  that  makes  you  a  medical  expert 
on  digestion?  All  of  you  breathe  every  second  of  your  lives.  Do  you  consider 
you  are  medical  experts  on  lung  diseases?"  You  would  know  you  are  not.  Just 
as  truly  no  woman  is  an  expert  on  childbearing  unless  she  has  medically  studied 
the  subject.  The  fact  of  bearing  children  or  not  bearing  them  does  not  make  her 
an  expert.  This  is  a  man's  measure  just  as  much  as  a  woman's,  and  I  speak  from 
personal  knowledge  when  I  say  that  I  think  the  woman  has  the  easiest  part  of  it. 
I  would  far  rather  be  the  woman  than  her  husband.  If  a  man  cares  for  his  wife  it 
is  much  harder  for  him  to  have  her  bear  a  child  than  it  is  for  her  to  bear  that  child. 
That  has  not  been  brought  out,  but  it  is  true.  You  all  know  that  it  is  true.  You 
not  only  have  the  anxiety  about  the  child's  life,  which  she  has,  but  you  have  the 
anxiety  about  her  life  and  the  suffering  in  her  suffering,  which,  though  vicarious, 
is  keener  than  hers.  Now,  as  men,  it  is  your  part  to  protect  your  women,  protect 
them  by  giving  them  proper  protection  not  improper  protection. 

Mr.  Graham.  Mrs.  Putnam,  do  I  understand  from  what  you  said  the  legitimate 
function  of  government  in  reference  to  these  cases  is  confined  to  giving  information, 
except  in  cases  of  poverty  Avhere  the  persons  in  need  of  care  are  unable  to  provide 
it  for  themselves?     Is  that  true,  do  you  think? 

Mrs.  Putnam.  I  do  not  think  I  have  said  anything  of  that  sort. 

Mr.  Newton.  I  know  you  did  not,  but  I  was  thinking  that  perhaps  was  a  legiti- 
mate conclusion  from  what  you  said. 

Mrs.  Putnam.  I  did  not  intend  to  say  anything  of  that  sort.  Of  course,  if  you 
choose,  you  can  establish  it  for  everyone,  like  the  public-school  system.  There  is 
certain  amount  of  socialism  which  we  all  agree  is  a  good  thing.  We  all  agree  as  to 
public  education,  education  at  public  expense,  because  we  think  it  is  better  for  the 
community  that  people  should  be  educated  than  uneducated.  We  all  believe  in 
public  water  supplies,  and  it  is  a  question  where  to  draw  the  line.  Personally,  I 
think  that  people  value  more  what  they  pay  for,  and  therefore  if  this  care  of  maternity 
could  be  furnished,  and  people  who  could  pay  were  encouraged  to  feel  that  it  wa; 
their  part  as  good  citizens  to  pay  for  the  care  they  got,  instead  of  leaving  it  to  the  State, 
I  think  it  probably  would  he  laetter,  but  I  can  not  discuss  socialism  because  I  really 
do  not  know  enough  about  it. 

Mr.  Newton.  Do  you  think  it  would  be  advisable  for  the  Government  to  provide 
physicians  to  be  paid  for  by  individuals  who  received  their  treatment? 

Mrs.  Putnam.  I  should  not  think  that  Avas  a  public  health  function,  but  a  private 
health  function,  the  treatment  of  disease. 

Mr.  Newton.  The  individual  who  has  the  money  and  is  able  to  provide  that  medica 
care  will  undoubtedly  provide  it  for  himself;  is  not  that  true? 

Mrs.  Putnam.  It  would  so  seem  to  me. 

Mr.  Newton.  But  on  the  other  hand,  there  is  clearly  an  obligation  on  society  to  pro 
vide  it  for  those  who  may  feel  unable  to  provide  it  for  themselves;  do  you  not  think  so't 

Mrs.  Putnam.  Yes;  in  a  measure  I  think  it  is  being  done  now — in  a  very  greaij 
measure. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  161 

Mr.  Newton.  Then,  would  it  not  follow  that  the  function  of  the  Government  would 
be  confined  to  giving  information  except  in  the  caseH  where 

Mrs.  Putnam.  No;  I  do  not  think  you  can  limit  it  in  that  Avay  without  7)auperizing 
the  people  who  receive  it.  I  think  yon  can  (jncouragc  tho.se  who  can  pay  to  pay,  Ijut 
the  question  is  whether  you  want  to  make  it  a  i)au])cr  matter.  It  iy  putting  a  premium, 
on  the  i)ropagation  of  the  least  fit  in  tlie  comnuinity.  If  it  is  a  public  health  matter, 
it  should  l)e  free  to  all,  ])ut  they  should  be  enc^ouraged  to  y)ay  for  it,  it  seems  to  me. 
You  see  what  1  mean  by  that  di^^tinction?  For  instance,  I  do  not  know  how  it  is  here, 
but  I  know  that  in  Boston  if  anyone  wants  milk  analyzed  they  can  take  it  to  the  city 
milk  inspector  and  have  it  analyzed  for  nothing.  That  is  free  to  all.  That  is  what  I 
mean. 

Mr.  Newton.  That  is  in  line  with  the  Public  Health  Service. 

Mrs.  Putnam.  That  is  in  line  with  the  Pu})lic  Health  Service. 

Mr.  Newton.  To  prevent  infection  or  contagion? 

Mrs.  Putnam.  Certainly. 

Mr.  Newton.  But  in  the  case  of  individual  diseases,  have  you  any  reason  why  the 
Government  should  pay  for  treating  the  individual  for  a  disease  that  is  not  infectious 
or  contagious? 

Mrs.  Putnam.  Theoretically,  there  is  no  reason  why  they  should  do  it  anyway. 
They  do  it  because — well,  because 

Mr.  Newton.  If  a  man  was  suffering  from  rheumatism,  would  there  be  any  rea- 
son  

Mrs.  Putnam.  Some  of  us  do. 

Mr.  Newton.  I  am  fully  aware  of  that,  having  experience  in  my  own  case.  Well, 
you  would  draw  the  line,  then,  at  that,  but  you  would  be  in  favor,  of  course,  of  public 
health  activities  to  arrest  infectious  or  contagious  diseases,  and  also  to  provide  treat- 
ment for  those  whose  poverty  prevented  them  from  providing  it  for  themselves? 

Mrs.  Putnam.  You  see,  this  measure  does  not  affect  any  of  the  cases  you  have 
spoken  of,  and  I  think  I  should  prefer  not  to  go  into  any  of  the  ramifications,  because  I 
have  not  given  serious  enough  thought  to  the  matter.  This  measure  is  a  measure  of 
preventive  medicine,  not  of  curing  disease.     There  is  a  great  distinction. 

Mr.  Newton.  It  has  the  fundamental  purpose,  though,  of  saving  human  life? 

Mrs.  Putnam.  But  to  prevent  the  existence  of  disease,  not  to  cure  it.  It  is  a  pre- 
ventive health  measure. 

Mr.  Newton.  Of  course,  that  is  only  one  phase  of  medicine,  is  it  not? 

Mrs.  Putnam.  Yes;  but  it  is  the  public  health  phase,  it  is  prevention.  When  they 
take  up  the  treatment  of  an  epidemic  they  do  not  treat  the  cases  of  disease;  they  treat 
them  as  preventing  the  spread  of  the  epidemic.  Public  health  ser\'ice  is  essentially 
preventive,  it  is  not  curative,  and  where  you  establish  free  hospitals  and  that  sort  of 
thing  it  is  simply  for  paupers  who  come  really  under  the  Board  of  Charities  rather 
than  the  Health  Board  in  that  case.     You  see  what  I  mean? 

Mr.  Newton.  Yes. 
I      Mrs.  Putnam.  I  have  some  rather  interesting  figures  to  give  you,  because  the  figures 
we  have  been  given  in  this  hearing  are  quite  odd.     They  do  not  hold  water  very  well . 
I  For  instance,  1  think  it  was  Mr.  Newton  who  asked  Dr.  Kosmak  the  other  day  about 
:  the  dates  of  the  comparable  figures,  and  he  was  mistaken  in  answering  that  the  figures 
I  for  the  United  States  were  prewar  figures  also.     They  were  not.     They  were  1918 
figures  and,  of  course,  1918  was  the  year  of  the  great  epidemic.     Even  in  1919— the 
figures  for  which  I  have  here — there  was  a  second  epidemic,  though  not  nearly  so 
severe,   that  must  be  borne  in  mind  when  you  compare  these  figures  with  the 
j)rew^ar  figures.     They  are  not  comparable  at  all.     You  can  not  put  things  of  two 
different  kinds  together  and  make  so  many  more  of  either  kind,  although  you  may 
■  remember  the  little  Sunday-school  boy  who  held  up  his  hand  and  said  that  you  could 
.  because,  he  said,  "I  have  often  seen  father  add  2  quarts  of  water  to  5  quarts  of  milk 
!  and  make  7  quarts  of  milk.  "     You  can  not  do  that.     You  can  not  compare  the  figures 
from  Belgium  for  1912  with  those  of  America  in  1918.     They  may  be  lower  now,  they 
may  be  higher  now.     Nothing  reliable  is  known  about  it,  and  it  is  arguing  on  an  en- 
tirely false  premise. 

I  have  here  the  mortality  census  for  1919,  which  says: 

"The  very  high  rate  (9.2)  in  1918  from  all  puerperal  causes  for  the  bii'th  registration 
area  was  imdoubtedly  due  to  the  influenza  epidemic.  Had  it  not  been  for  the  same 
I  factor  in  1919  and  the  addition  of  three  Stja^tes  to  the  birth  registration  area  in  1919, 
\  it  is  estimated  from  unpublished  figures  in  the  Bureau  of  the  Census  that  the  1919 
J  rate  would  have  been  no  higher  than  the  1915  or  1916  rate.  Special  attention  is  called 
?|  to  the  fact  that  for  both  white  and  colored  for  each  of  the  five  years,  1915  to  1919,  the 
l|  rates  from  all  puerperal  causes  and  puerperal  septicemis  are,  without  exception  lower 
1  for  the  rural  parts  of  the  biith  registration  area  than  for  the  urban. 


74G54— 21 11 


I 


162  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

"Among  the  States  shown  for  1919,  South  Carolina  has  the  highest  rate  (11.2)  from 
all  puerperal  causes,  and  Wisconsin  the  lowest  (4.8).  Among  the  cities  shown  in 
1919,  Scranton  has  the  highest  rate  (11.8)  from  all  puerperal  casuses,  and  New  Haven 
and  Fall  River  the  lowest  (each  4.1).  " 

I  wanted  to  read  that  because  I  wanted  to  read  that  about  Fall  River.  Fall  River 
has  been  notoriously  bad  in  its  infant  mortality.  It  is  a  district  which  is  very  crowded 
with  a  poor  mill  population  of  the  poorer  class.  New  Bedford  makes  a  finer  grade  of 
goods  and  has  a  finer  grade  of  operatives.  I  think  it  is  rather  significant  that  Fall 
River  should  be  one  of  the  two  lowest  places  within  the  registration  area,  when  it  has 
always  had  a  population  in  poor  social  econoroic  circumstances. 

Mr.  Johnson.  I  want  to  ask  you  one  or  two  questions,  Mrs.  Putnam.  I  do  not 
know  who  else  is  going  to  testify,  and  I  do  not  know  whether  I  will  have  an  opportu- 
nity to  ask  any  one  else  who  knows  as  much  about  it  as  you.  In  your  study  and  obser- 
vation did  you  have  opportunity  to  ascertain  or  learn  the  causes  of  the  greater  num- 
ber of  fatalities  to  mothers  at  the  time  of  childbirth? 

Mrs.  Putnam.  Do  you  mean  actually  at  the  time,  or  including  the  whole  puerperal 
period? 

Mr.  Johnson.  Including  that? 

Mrs.  Putnam.  That  is  nine  months  before  birth? 

Mr.  Johnson-.  I  just  wanted  to  know,  first,  whether  you  had  an  opportunity  to 
get  that  information? 

Mrs.  Putnam.  It  is  all  in  the  statistics  here  in  the  census. 

Mr.  Johnson.  I  am  talking  about  youir  own  observation? 

Mrs.  Putnam.  My  own  work? 

Mr.  Johnson.  Yes. 

Mrs.  Putnam.  I  was  at  that  time  doing  only  prenatal  work.  Now  I  am  carrying 
it  on  further  but  I  have  not  had  enough  cases  yet. 

Mr.  Johnson.  Are  you  able  to  state  to  the  committee 

Mrs.  Putnam.  The  principal  causes? 

Mr.  Johnson.  The  principal  causes  of  fatalities  to  the  mothers  at  the  time  of  child- 
birth, or  preceding  birth? 

Mrs.  Putnam.  I  think  there  are  two.  I  think  they  are  from  puerperal  sepsis, 
which  is  an  infection  acquired  almost  always  through  dirty  handling,  and  which 
occurs  after  childbirth,  and  toxemia,  a  poisoning  which  ends  in  eclampsia,  which  is 
commonly  called  convulsions,  which  is  an  infection  peculiar  to  pregnancy.  It 
involves  the  kidneys  and  various  other  things.  It  is  not  kidney  disease,  and  it  is 
not  Bright's  disease,  but  a  disease  peculiar  to  pregnancy. 

Mr.  Johnson.  I  have  often  heard  doctors  state  that  women  during  that  period  had 
Bright's  disease,  or  something  of  that  kind? 

Mrs.  Putnam.  It  is  not  Bright's  disease ;  it  is  eclampsia,  and  it  has  no  common  name, 
I  am  sorry  to  say. 

Mr.  Johnson.  Those  causes  you  have  mentioned,  it  would  seem  to  me,  are  purely 
medical  conditions  requiring  medical  attention? 

Mrs.  Putnam.  Absolutely. 

Mr.  Johnson.  Have  you  had  an  opportunity  to  draw  any  conclusions  satisfactory 
to  yourself  as  to  the  causes  of  fatality  to  the  child  in  child-birth,  as  to  the  most  frequent 
causes,  I  mean? 

Mrs.  Putnam.  Not  from  my  own  observation.  According  to  the  census  the  most 
frequent  cause  is  from  malformations. 

Mr.  Johnson.  What  do  you  mean  by  that? 

Mrs.  Putnam.  Here  are  the  principal  causes  of  infant  deaths  given.  I  think  I 
have  it  here.  This  is  a  list  of  the  diseases  that  are  given  as  causes  of  the  deaths  of 
infants.  The  principal  diseases,  or  the  principal  causes  of  fatality  are,  first  of  all 
premature  birth ;  second — I  am  giving  you  now  all  the  diseases  during  the  first  year 
of  life.  The  greatest  and  most  serious  is  premature  birth;  the  second  one  is  diarrhea 
and  enteritis;  the  third  is  congenital  debidty;  the  fourth,  bronchial  pneumonia;  the 
fifth,  influenza;  the  sixth — I  may  be  giving  these  a  little  wrong,  because  they  are 
not  listed  in  the  order  of  frequency  and  so  I  have  to  skip  about — the  sixth  is  injuries 
at  birth;  the  seventh,  pneumonia,  and  did  I  read  the  congenital  malformations? 
No,  I  skipped  that.  Congenital  malformations  come  next  to  bronchial  pneumonia,  i 
and  before  the  injuries  at  birth.     Then,  after  that,  next  comes  acute  bronchitis. 

Mr.  Johnson.  Now,  that  information  you  have  given  us  is  quite  interesting  to  me. 
I  do  not  know  anything  about  the  subject  m}  self.  Are  there  any  of  those  diseases 
for  causes  of  fatality  there  that  you  think  could  be  avoided  by  the  nurse  as  well  as 
by  the  physician  or  the  advice  of  a  physician? 

Mrs.  Putnam.  Yes;  all  of  them,  practically.  I  am  not  so  sure  about  malformations, 
but  T  have  no  doubt  that  even  they  could  be  in  a  measure.     Of  course,  injuries  at 


_J 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  163 

birth,  conp^onital  debility  and  premature  birth  are  all  readily  prevented.  As  I  told 
you,  in  our  pro-iuittil  work  we  reduced  premature  birthH  to  Heven-tenthe  of  1  per  cent, 
which  is  almost  nothiiif,'. 

Mr.  Johnson.  My  question  was,  do  you  think  those  matters  can  be  handled  as 
well  or  better  by  nurses  or  by  physicians,  and  if  so,  why  should  we  have  them? 

Mrs.  PuTN.VM.  Certainly  not. 

Mr.  Johnson.  I  understood  yoti  to  say  they  could? 

Mrs.  Putnam.  Not  at  all.  I  said  they  were  medical.  A  nurse  can  handle  them, 
but  only  under  medical  supervision.  The  nurse  is  very  valuable  as  eyes  and  ears 
for  the  doctor,  to  go  to  see  the  patient  and  to  report  back  to  the  doctor.  That  is  the 
most  reasonable  thing  for  her  to  do.  It  is  unnecessary  for  a  doctor  to  visit  a  person 
who  is  in  perfect  health  if  he  can  send  a  nurse  instead  to  see  that  that  person  keeps 
in  perfect  health.  You  must  remember  this  is  preventive  medicine  absolutely. 
For  the  doctor  not  to  employ  a  nurse  in  preventive  prenatal  visits  would  be  like 
insisting  upon  employing  doctors  as  his  clerks,  or,  if  you  are  a  lawyer,  as  if  you  were 
to  insist  on  your  stenographer  being  a  lawyer  also.  A  nurse  takes  the  position  toward 
the  doctor  that  your  secretary  takes  to  you,  a  very  great  help  and  addition,  who 
can  save  you  a  great  deal  of  routine  work,  but  he  does  not  take  your  place. 

Mr.  IIawes.  Mrs.  Putnam,  you  object  to  the  lay  management  of  a  board  of  this 
kind? 

Mrs.  Putnam.  I  do. 

Mr.  Hawes.  And  yet  you  yourself  are  the  very  best  denial  of  your  own  assertion. 
You  have  proved  a  most  wonderfully  intelligent,  well-informed  witness,  and  yet  you 
I  are  in  the  lay  class  yourself,  are  you  not? 

'  Mrs.  Putnam.  Yes;  that  would  seem,  offhand,  like  a  very  good  argument,  but  I 
;put  myself  under  the  best  medical  supervision  I  could  find  in  running  my  experiment. 

Mr.  ITawes.  The  real  question  I  desire  to  ask  is  this 

Mrs.  Putnam.  Under  the  best  doctors  that  I  could  find. 
1     Mr.  Hawes.  The  committee  has  before  it  a  problem  on  which  the  witnesses  are 
divided — what  portion  of  this  work  is  medicinal  and  what  portion  of  it  sociological. 
If  this  committee  could  separate  the  medicinal  and  confine  this  work  to  the  sociological 
would  you  have  any  objection  to  that? 

Mrs.  Putnam.  I  think  it  would  be  a  useless  bill. 

Mr.  Hawes.  In  the  matter  of  education  it  would  not  be? 

Mrs.  Putnam.  In  the  care  of  maternity  you  can  not  educate  a  woman  to  do  more 
ithan  choose  a  good  physician  to  take  care  of  her.  The  rest  of  the  education  you  can 
give  her  can  be  given  in  two  minutes. 

Mr.  Hawes.  Where  a  nurse  can  not  be  furnished,  and  the  agent  of  the  State  gov- 
ernment, assuming  you  are  under  State  control,  goes  into  the  family  to  direct  the 
family  to  a  certain  extent,  would  not  that  be  a  valuable  aid? 

]  Mrs.  Putnam.  Not  in  my  opinion.  I  think  it  would  be  a  very  dangerous  thing, 
because  I  think  it  would  lull  with  a  false  sense  of  security  and  prevent  the  patient 
from  seeing  a  doctor  when  she  otherwise  might. 

:  Mr.  Hawes.  What  percentage  of  the  mortality  in  these  cases  do  you  think  is  due 
;to  malnutrition  and  bad  nursing,  or  to  disease? 

Mrs.  Putnam.  Well,  a  great  deal  of  it  is  due  to  bad  conditions,  neither  malnutrition 
nor  disease,  but  lack  of  proper  care  of  the  mother,  lack  of  care  against  the  beginning 
of  the  disease,  we  will  say,  the  forerunner  of  disease. 

Mr.  Hawes.  A  very  intelligent  witness  stated  that  this  subject  could  be  divided 
into  three  classes,  the  economic,  the  sociological,  and  the  medicinal.  In  what  pro- 
portion do  you  think  they  bear  to  the  general  result? 

Mrs.  Putnam.  Well,  the  only  investigations  that  I  know  of  which  have  been  made 
in  the  matter  have  gone  to  prove  that  in  the  actual  care  of  maternity — I  am  not  speak- 
ing of  the  child  after  the  first  month— the  conditions  are  very  different  after  the  first 
month — child  hygiene  is  very  much  affected  by  economic  conditions — but  maternal 
mortality  and  the  mortality  of  the  child  in  the  first  month  of  life  appear  to  be  but 
, little  affected  by  social  and  economic  conditions.     They  are  almost  negligible. 

Mr.  Hawes.  The  economic  situation  and  the  social  situation  are  a  matter  of  poverty, 
the  lack  of  means  to  supply  the  mother  and  child  with  proper  attention? 

Mrs.  Putnam.  I  did  not  understand  that. 

Mr.  Hawes.  I  mean  the  sociolo2;ical  condition  is  lirought  about  by  the  house  the 
mother  and  child  live  in,  the  clothes  they  wear,  and  the  food  they  eat.  I  mean  that 
economic  means  the  possession  or  lack  of  possesion  of  three  essential  things,  a  habita- 
tion, food,  and  clothing? 

Mrs.  Putnam.  Yes;  I  am  waiting  for  a  question. 

Mr.  Hawes.  The  question  is  what  part  do  thev  plav,  relatively,  'nath  the  medical 
end? 

Mrs.  Putnam.  A  very  small  part  in  maternity  care;  in  child  hygiene,  a  very  large 
part. 


164  PUBLIC   PEOTECTION   OF   MATERNITY  AND   INFANCY. 

J 

Mr.  Ha  WES.  I  think  one  physician  stated  that,  relatively,  the  medicinal  portion    | 
was  95  per  cent  as  against  5  per  cent.    Would  you  disagree  with  that? 

Mrs.  Putnam.  I  should  think  he  was  very  likely  correct,  but  I  can  not  possibly 
form  an  estimate.  You  would  have  to  know  the  whole  subject  from  A  to  Z,  and  a 
great  many  details  to  form  any  accurate  statement  of  percentages.  I  only  can  say 
that  the  medical  is  so  infinitely  the  most  important,  in  my  mind,  of  the  three  that 
the  others  sink  into  insignificance  beside  it,  but  as  to  the  actual  percentage  I  could 
not  give  you  that. 

Mr.  Hawes.  We  find  that  at  the  head  of  the  Navy  Department  there  is  a  man  who 
to-day  has  had  some  experitnce  with  the  Navy,  but  in  the  past  has  never  had  any, 
and  we  find  that  is  true  in  connection  with  the  Army.  Would  it  not  follow  that  a 
layman  or  laywoman  with  your  particular  capacity  and  training,  could  select  doctors 
to  administer  a  bureau  of  this  kind  as  efficiently 

Mrs.  Putnam  (interposing).  Not  necessarily.  I  do  not  know  how  efficiently  the 
Army  and  Navy  are  selecting  theirs.  Do  you  not  see  you  are  asking  me  a  question 
that  I  can  not  possibly  answer?    I  can  only  say  that  I  do  not  think  it  is  a  safe  risk  to 

Mr.  E-AYBURN.  Your  contention  is  that  this  whole  subject  is  medical,  the  great 
proportion  of  it,  or  the  great  majority  of  it? 

Mrs.  Putnam.  Yes. 

Mr.  Eayburn.  And  that  it  is  only  safe  for  the  women  and  children  that  it  be  con- 
sidered so? 

Mrs.  Putnam.  That  is  true. 

Mr.  Rayburn.  By  Congress? 

Mrs.  Putnam.  Absolutely. 

Mr.  Rayburn.  Mr.  Chairman,  I  want  to  say,  as  one  member  of  this  committee, 
that  I  appreciate  almost  beyond  expression  having  a  witness  come  here  with  so  full 
information,  so  sane  and  so  able,  as  the  one  we  have  had  this  morning,  whether  we 
agree  with  all  of  her  conclusions  or  not. 

Mrs.  Putnam.  Thank  you,  sir. 

Mr.  Lea.  In  the  first  place,  I  want  to  concur  in  what  Mr.  Rayburn  said,  but  I  would 
like  to  go  a  little  further  and  get  an  expression  from  you  as  to  your  views  as  to  what 
is  practical  publicity  in  these  matters.  I  understand  you  are  in  favor  of  publicity, 
but  are  not  in  favor  of  lectures  provided  for  in  the  bill.  Now,  will  you  explain  your 
position  a  little  further  on  that? 

Mrs.  Putnam.  Well,  it  is  a  little  difficult,  except  that  I  think  that  I  can  safely  say 
that  I  think  the  publicity  should  be  medical,  the  lectures  should  be  given  by  medical 
people,  unless  they  are  lectures  prepared  by  medical  people  and  delivered  by  lay 
people,  but  even  that  is  not  satisfactory  because  they  can  not  answer  the  questions. 

Mr.  Lea.  Your  objection,  then,  is  not  so  much  to  a  lecture,  but  it  is  with  respect 
to  the  person  who  should  give  that  lecture? 

Mrs.  Putnam.  That  is  it  exactly. 

(The  letters  and  papers  submitted  by  Mrs.  Putnam  are  as  follows:) 

Mrs.  William  Lowell  Putnam,  July  11,  1921. 

Boston,  Mass. 

My  Dear  Mrs.  Putnam:  I  am  very  anxious  to  see  a  bureau  or  department  of  public 
health  started  which  shall  incorporate  among  its  activities  those  dealing  with  maternal 
as  well  as  child  welfare. 

Most  cordially,  yours,  F.  L.  Adair. 

American  Medical  Association, 

Chicago,  July  12,  1921. 
Mrs.  William  L.  Putnam, 

New  Willard  Hotel,  Washington,  D.  C. 
Dear  Mrs.  Putnam:  I  find  your  letter  of  June  24  and  July  6  on  rettirn  to  the  office 
(this  morning.     As  I  have  just  returned  from  a  two  weeks'  trip,  it  would  be  impossible 
for  me  to  get  away  again  at  present. 

Thank  you  for  theinformation  regarding  existing  conditions.  My  personal  feeling 
is,  if  the  Federal  Government  is  going  to  expend  any  money  on  maternal  and  infant 
•welfare  along  the  line  provided  for  in  the  Sheppard-Towner  bill,  the  work  should  be 
Tunder  the  direction  of  the  United  States  Public  Health  Service.  All  that  is  necessary 
^to  do  is  to  amend  the  bill,  substituting  United  States  Public  Health  Service  for  the 
'Children's  Bureau  in  every  case. 
■(Siwrdially,  yours, 

Frederick  R.  Green, 
Council  on  Health  and  Public  Instruction. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  165 

RESOLUTIONS  OF  AMERICAN  GYNECOLOGICAL  SOCIETY  IN  REGARD  TO  SHEPPARU-TOWNER. 

BILL. 

This  society  wiehes  definitely  to  state  its  position  for  the  information  of  the  medical 
profession  and  others  who  are  interested  in  this  legislative  profjram. 

1.  The  committee  is  in  thorough  accord  with  the  ends  whi(  h  this  bill  seeks  to  attain, 
namely,  the  ])rotection  of  the  health  of  mothers  and  infants. 

2.  We  indorse  the  coordination  of  all  health  activities  under  one  head.  We  con- 
sider the  protection  of  mothers  and  infants  to  be  a  health  measure  of  jjaramount  im- 
portance to  the  individual  and  the  State. 

3.  We  oppose  in  principle  the  control  of  health  measures  by  nonmedical  individuals 
or  boards. 

4.  We  believe  in  the  local  control  of  health  activities  as  distinguished  from  Federal. 
We  approve  and  indorse  the  idea  of  propaganda  and  investigation  emanating  from  the 
Federal  (iovernment. 

5.  We  do  not  indorse  the  Sheppard-Towner  bill  in  its  present  form,  becouse  it  does 
not  conform  to  the  above  ])rinciples  and  because  it  embodies  the  questionable  plan 
of  subsidizing  State  health  activities. 

6.  We  indorse  the  project  of  establishing  a  national  department  of  health. 

George  Gray  Ward,  Jr.,  President. 
Arthur  II.  Curtis,  Secretary. 
George  W.  Kosmak. 
Fred  J.  Taussig. 
Fred  L.  Adair. 


Transactions  of  the  Conference  op  Health  Officers  and  Faculty  Members 
Regarding  Problems  Relating  to  County  Health  Work,  Held  at  Johns  Hop- 
kins School  of  Hygiene  and  Public  Health,  December  15  and  16,  1920. 

report  of  the  committee  on  maternity  and  child  hygiene. 

This  committee  emphasizes  the  importance  of  promoting  in  every  State,  as  part  of 
the  official  public  health  work  of  National,  State,  and  local  public  health  authorities, 
work  for  the  protection  of  maternal  and  child  life. 

The  committee  is  of  the  opinion  that  additional  action  is  urgently  needed  to  secure 
complete  birth  registration  throughout  the  country. 

A  complete  program  of  work  for  the  protection  of  maternal  and  child  life  should 
insure  adequate  antenatal,  obstetric,  and  postnatal  advice  and  assistance  for  every 
lying-in  woman.     To  this  end: 

(1)  The  instruction  of  medical  students  in  maternity  work  should  be  extended  and 
improved. 

(2)  Where  midwives  can  not  be  eliminated  from  practice,  they  should  be  strictly 
regulated  and  supervised,  and  subjected  to  examination  as  to  competency. 

(3)  There  is  great  need  in  most  areas  for  additional  institutional  accommodation  for 
lying-in  women,  the  methods  of  provision  to  be  determined  by  local  circumstances. 

(4)  Health  centers,  where  not  already  established,  should' be  provided,  having 
specially  in  view  the  institution  of — ■ 

(a)  Antenatal  consultations. 

(b)  Infant  consultations  and  clinics. 

(5)  An  adequate  staff  of  public  health  nurses  should  be  provided  to  secure  reg- 
ular visitation  of  mothers  and  infants,  to  cover  the  antenatal,  infantile,  and  preschool 
periods. 

(6)  There  should  be  active  educational  work  for  the  promotion  of  personal  hygiene 
with  special  reference  to  the  hygiene  of  infancy  and  childhood. 

The  committee  favors  a  carefully  devised  system  of  Federal  aid  extension  for  pro- 
moting public  health  work,  of  which  measures  for  the  protection  of  maternal  and  child 
life  should  be  an  important  part. 

Arthur  Newsholme. 

S.  J.  Crumhine. 

J.  W.  Schereschewsky. 

The  Chairman.  Mrs.  Putnam,  we  are  greatly  obliged  for  your  testimony.     At  this 

I'  point  I  would  like  to  dispose  of  an  important  letter,  for  the  reason  that  the  writer  has 

apparently  been  regarded  as  so  important  as  to  be  referred  to  on  both  sides  of  this 

discussion.     I    refer   to   Dr.  J.  A^Taitridge  Williams,  the   chief   obstetrician   of  the 


166  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Johns  Hopkins  Hospital.  You  will  rembmer  that  he  has  been  referred  to  as  being 
on  both  sides  of  this  question.  A  letter  written  by  him,  dated  Baltimore,  July  12, 
1921,  addressed  to  the  chairman  of  this  committee,  reads  as  follows: 

"I  had  expected  to  attend  the  hearing  to-day  on  the  Sheppard-Towner  bill,  but 
unfortunately  was  prevented  from  doing  so.  As  I  did  not  have  an  opportunity  to 
say  publicly  what  I  think,  I  am  taking  the  liberty  of  writing  you. 

"I  hope  that  the  bill  in  its  present  form  will  go  through,  as  I  feel  very  strongly  that 
the  matters  covered  by  it  should  be  directed  by  physicians  and  not  by  laymen.  Con- 
sequently, I  hope  that  if  anything  is  done  in  the  matter,  that  the  direction  wUl  be 
put  in  the  Public  Health  Service,  at  least  pending  the  formation  of  a  national  depart- 
ment of  health. 

"In  making  this  recommendation,  I  hope  you  will  understand  that  I  am  making  no 
criticism  of  Miss  Lathrop,  the  head  of  the  Children's  Bureau.     She  has  done  extremely 
well  in  her  post,  but  I  do  not  feel  that  the  Department  of  Labor  is  the  branch  of  the 
Government  which  should  have  to  deal  with  medical  matters. 
"Regretting  to  trouble  you,  I  am,  yours,  very  truly, 

"J.  Whitridge  Williams." 

I  will  now  take  the  liberty  of  calling  on  Dr.  Stewart. 

STATEMENT  OF  DR.  MARGARET  STEWART,  800  CARROLL  AVENUE, 
TAKOMA  PARK,  D.  C. 

The  Chairman.  What  is  your  occupation? 

Dr.  Stewart.  I  am  a  physician. 

The  Chairman.  The  chairman  wishes  to  state  to  the  committee  that  he  has  asked 
Dr.  Stewart  to  be  present,  in  view  of  the  fact  that  she  is  connected  as  a  physician  with 
the  Public  Health  Service,  and  it  seems  to  the  chairman  that  it  would  be  well,  in 
view  of  the  discussion  that  has  taken  place,  for  her  to  state  what  she  knew,  or  state,  at 
all  events,  about  the  work  being  done  by  the  Public  Health  Service  along  the  general 
lines  contemplated  and  under  consideration  in  the  provisions  of  this  bill.  Will  you 
kindly  tell  your  story,  Doctor? 

Dr.  Stewart.  In  the  fall  of  1917  I  was  called  by  the  Public  Health  Service  to  go 
down  to  Fort  Worth,  Tex.,  in  the  extra  cantonment  work.  My  work  was  to  be  in 
charge  of  the  child  hygiene  work  for  the  prevention  of  contagious  diseases,  and  general 
work  among  the  children  and  babies.  There  was  no  school  inspection  in  the  city  of 
Fort  Worth.  There  never  had  been,  with  the  exception  of  one  year  some  years  pre- 
vious, but  it  had  not  proved  very  satisfactory.  We  examined  most  of  the  children  of 
Fort  Worth.  We  examined  all  the  school  children,  including  the  eighth  grade,  but 
we  did  not  go  into  the  high  schools.  We  examined  primary  schools,  beginning  with 
the  kindergarten  and  primary.  The  way  we  did  it  was  to  weigh  and  measure  each 
child,  to  examine  the  heart,  lungs,  mouth,  teeth,  and  eyes,  carefully  noting  whether 
the  child  was  properly  nourished,  and  then  give  such  instructions  as  seemed  necessary. 
If  the  mother  was  not  there,  we  would  write  a  little  note  to  the  mother,  advising  her 
of  her  child's  condition.  Probably  we  might  say  only,  "This  child  needs  her  tonsils 
removed,"  or  "This  child  is  undernourished."  We  did  no  medical  work,  but  merely 
medical  educational  work.  We  gave  leaflets  to  undernourished  children  relative  to 
diet  and  the  necessity  of  milk;  also  advice  as  to  the  harmful  effects  of  coffee  and  tea. 

We  found  out  that  there  Were  eight  times  as  many  cases  of  smallpox  in  the  previous 
year  in  Fort  Worth  as  there  were  in  New  York  City.  We  also  found  out  that  there  was 
no  compulsory  vaccination.  We  had  to  educate  the  children  and  educate  the  mothers 
to  the  necessity  of  vaccination,  and  we  did  vaccinate,  during  our  school-inspection 
work,  about  two-thirds  of  the  school  children.  We  made,  I  think,  quite  a  very  careful 
examination.  We  discovered  two  or  three  cases  of  trachoma  in  almost  every  school 
that  we  examined.  We  discovered  cases  of  scarlet  fever  in  the  acute  stage,  the  pupils 
having  the  disease  sitting  in  the  school  room  with  the  other  children.  We  discovered 
a  few  cases  of  smallpox  in  the  school  room.  We  naturally  sent  them  home,  reported  the 
case  to  the  health  authorities,  and  we  told  them  immediately  to  send  for  the  family 
physician. 

The  doctors  cooperated  with  us.  We  did  not  do  the  medical  work,  but  we  told  the 
parents  what  was  necessary. 

We  also  gave  lectures.  In  every  schoolroom  we  talked  about  10  minutes  after  we 
had  completed  the  examinations.  We  called  all  the  children  together  and  told  them 
how  to  clean  their  teeth,  told  them  how  to  care  for  themselves,  told  them  the  kind  of 
food  that  was  necessary  to  build  up  muscles,  bone,  nerves,  et  cetera,  and  then  we 
would  go  to  another  schoolroom. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  167 

In  the  meantime  we  started  a  babies'  clinic.  We  had  it  in  the  basement  of  one  of 
the  churches  of  the  city,  and  the  object  of  the  clinic  was  the  examination  of  and  advice 
to  expectant  mothers  and  for  the  examination  of  J)abies  and  children  of  preschool  age. 
Milk  was  supplied  free  for  the  poor  bal)ies  by  a  city  newspaper;  also  ice  was  supplied 
by  another  paper  to  the  clinic  where  the  milk  was  pasteurized  and  the  mothers  taught 
how  to  do  it  for  their  babies  at  home. 

We  gave  about  three  lectures  a  week  to  parents,  teachers'  clubs,  or  various  women's 
clubs  in  churches  and  halls.  We  talked  to  reporters  wherever  they  wanted  to  talk  to 
us,  so  that  nearly  oA'ery  day  there  was  something  of  a  medical  educational  nature  in 
print  in  the  pai)ers. 

After  I  left  there,  when  our  school  work  was  completed,  I  went  to  Cary,  Ind.,  with 
the  Children's  Bureau.     The  bureau  was  making  an  investigation  in  that  city. 

The  Chairman.  You  mean  that  you  became  attached  to  the  Children's  liureau? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  Did  you  leave  the  Public  Health  Service  or  were  you  merely  detailed 
or  assigned  to  the  Chileren's  ]>ureau? 

Dr.  Stewart.  I  left  the  Public  Health  Service,  with  their  permission,  temporarily. 
I  found  that  in  Gary,  Ind.,  there  were  possibly  a  few  more  doctors  than  we  had  in  Fort 
Worth,  Tex.  I  do  not  remember  the  number  now,  but  there  may  have  been  four  or 
five  physicians  there.  They  were  also  doing  medical  work.  They  were  examining 
the  school  children  and  they  had  baby  clinics,  and  the  work  was  very  efficiently  done. 
The  examination  of  the  chest  and  of  the  mouth  and  special  individual  instruction 
which  was  given  was  all  as  efficiently  done  as  the  Public  Health  Service  did  it  in  Fort 
Worth. 

We  had  no  public  lectures,  except  that  during  the  three  months  that  I  was  there 
there  was  one  medical  lecture  given.  The  doctors  were  not  allowed  to  see  the  reporters. 
The  social  worker  had  charge  of  the  service.  The  doctors  were  working  under  the 
social  worker.  We  were  not  supposed  to  see  a  reporter.  We  were  not  allowed  to  give 
lectures  unless  it  was  arranged  by  the  social  worker.  We  did  no  vaccination.  We  did 
no  pasteurization  of  milk.     I  was  a  little  disappointed. 

The  Chairm.^n.  Will  you  pardon  an  interruption?  What  do  you  mean  when  you 
say  that  you  were  not  allowed?    Who  restricted  your  operations? 

JDr.  Stewart.  The  social  worker  who  had  charge  of  the  field. 

The  Chairman.  As  representing  what  body? 

Dr.  Stewart.  The  Children's  Bureau. 

The  Chairman.  That  is  to  say,  the  medical  effort  of  yourself  and  four  or  five  others 
came  under  the  direction  and  super\dsion  and  control  of  a  social  worker  appointed  by 
the  Children's  Bureau  from  Washington? 

Dr.  Stewart.  Yes.  There  was  a  medical  woman  in  charge  of  the  medical  work, 
but  it  was  all  under  the  general  direction  of  the  social-service  workers. 

The  Chairman.  And  the  medical  woman  in  charge  had  to  report  to  that  social 
worker? 

Dr.  Stewart.  The  medical  woman  in  charge  could  not  go  ahead  and  arrange 
lectures  without  having  the  consent  of  the  social  worker  who  was  in  charge  of  the  work 
at  Gary. 

The  Chairman.  How  far  did  the  jurisdiction  of  that  social  -worker  go? 

Dr.  Stewart.  Well,  I  could  not  tell  you.    Just  what  do  you  mean? 

The  Chairman.  I  mean  this:  Did  she  control  the  movement  of  the  medical  men, 
once  they  got  under  way?  Could  she  stop  any  line  of  work  or  inquiry  or  could  she 
initiate  it? 

Dr.  Stewart.  Yes;  but  she  was  pretty  liberal.  She  let  the  doctors  do  pretty  much 
as  they  chose,  but  we  did  not  have  an  opportunity  of  going  ahead  and  launching  out 
into  things  that  I  had  been  accustomed  to  doing  and  that  seemed  so  ^^ltally  important 
to  a  physician. 

The  Chairman.  It  was  still  subject  to  her  decision  whether  you  did  and  did  not  do 
anything  at  any  time? 

Dr.  Stewart.  Yes. 

The  Chairman.  Whether  your  medical  women  suggested  that  you  should  or  should 
not,  it  made  no  difference,  because  she  was  still  in  control? 

Dr.  Stewart.  Well,  the  doctors  were  under  the  physician  who  was  in  charge,  but 
the  whole  ser\dce  was  under  the  social  worker  in  charge,  in  the  same  building,  in  the 
next  room. 

The  Chairman.  To  use  a  common  expression,  she  was  boss  out  there? 

Dr.  Stewart.  Yes. 

Feeling  that  the  work  was  not  being  done  quite  so  much  for  the  benefit  of  the  public 
as  the  work  that  I  had  just  left,  I  began  figuring  up  the  cost  of  the  two  stations.  1 
added  all  of  our  salaries  and  the  regular  expenses,  and  taking  into  consideration 


168  PUBLIC  PROTECTION   OP  MATERNITY  AND  INFANCY. 

the  number  of  patients  that  we  examined,  mothers,  babies  and  children,  and  I 
found  out  that  in  Fort  Worth,  Tex.,  it  cost  the  Government  88  cents  for  each  child 
that  was  examined.  I  found  in  making  the  same  estimate  that  our  organization,  the 
medical  part  of  our  organization  in  Gary,  Ind.,  cost  considerably  more  than  $2 — I 
can  not  remember  the  exact  cost  for  the  examination  of  each  child. 

The  Chairman.  Can  you  account  for  the  expense  which  went  to  make  up  that 
difference? 

Dr.  Stewart.  It  was  an  organization  that  was  so  well  organized  that  it  was  cum- 
bersome and  expensive.  For  instance,  two  people  examined  and  weighed  the  children 
and  a  social  worker  was  clerk  for  the  doctor.  The  expense  incurred  in  the  organization 
was  very  much  more  than  our  simple  organization  at  Fort  Worth,  and  yet,  as  I  said, 
we  gave  no  lectures  except  the  one  lecture  while  I  was  there,  and  no  children  were 
vaccinated,  and  there  was  no  pasteurization  of  milk,  although  most  of  the  dairies  were 
supplying  the  city  with  raw  milk. 

The  Chairman.  Do  you  happen  to  know.  Doctor,  anything  about  the  further  work 
done  by  either  one  of  these  bureaus  in  other  places?  You  mentioned  Gary,  which  is  a 
suburb  of  Chicago. 

Dr.  Stewart.  That  was  my  only  experience  with  the  Children's  Bureau. 

The  Chairman.  Do  you  happen  to  know  of  any  other  station  where  the  Children's 
Bureau  did  carry  on  this  work? 

Dr.  Stewart.  No;  I  could  not  give  you  information  as  to  that. 

The  Chairman.  Do  you  know  of  any  other  station  carried  on  by  the  Public  Health 
Service? 

Dr.  Stewart.  Yes ;  there  were  very  many.  Every  extra  cantonment  zone  was  being 
cared  for  the  same  as  Fort  Worth,  Tex. ,  was. 

The  Chairman.  That  is  all  over  the  country? 

Dr.  Stewart.  That  was  all  over  the  country. 

Mr.  Newton.  When  was  this  work  done  at  Fort  Worth,  Doctor? 

Dr.  Stewart.  In  the  summer  of  1917  it  started. 

Mr.  Newton  .  And  is  work  similar  to  that  now  being  carried  on  by  the  Public  Health 
Service? 

Dr.  Stewart.  After  the  Public  Health  Service  had  left,  the  city  of  Fort  Worth 
issued  bonds  to  carry  on  the  work  itself. 

Mr.  Newton.  What  I  was  getting  at  was  whether  work  similar  to  what  they  carried 
on  in  Fort  Worth  is  now  being  carried  on  at  any  station  in  the  country. 

Dr.  Stewart.  Someone  who  has  charge  of  it  could  better  answer  that.  I  am  in  the 
tuberculosis  work  now. 

The  Chairman  .  I  will  say  for  the  information  of  the  committee  that  on  the  invitation 
of  the  Chairman,  representatives  of  the  Public  Health  Service  will  be  here  to-morrow, 
and  will  give  statistics  or  any  information  the  committee  may  desire. 

Mr.  Newton.  How  large  an  organization  did  you  have  at  Fort  Worth? 

Dr.  Stewart.  We  had  three  physicians  and  three  nurses. 

Mr.  Newton.  And  you  were  there  for  about  h'ow  long? 

Dr.  Stewart.  During  the  school  year,  from  the  fall  of  1917  until  about  May,  1918. 

Mr.  Newton.  And  you  took  all  of  the  schools,  public  and  private? 

Dr.  Stewart.  We  did  not  go  into  all  of  the  parochial  schools. 

Mr.  Newton.  Did  you  take  in  both  colored  and  white  schools? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  How  long  were  you  at  Gary,  Ind.? 

Dr.  Stewart.  I  was  at  Gary,  Ind.,  three  months. 

Mr.  Newton.  How  large  an  organization  was  there  there? 

•Dr.  Stewart.  Aside  from  the  medical  work,  there  were  many  social  workers. 

Mr.  Newton.  That  is  what  I  want  to  get  at,  the  total  organization,  and  then  how 
much  was  devoted  to  the  medical  phase  of  it. 

Dr.  Stewart.  I  do  not  remember  just  how  many.  It  was  quite  an  organization. 
I  think  there  were  about  five  physicians,  three  nurses,  and  I  could  not  tell  you  how 
many  social  workers. 

Mr.  Newton.  Can  you  give  us  the  approximate  number? 

Dr.  Stewart.  The  difference  meant  a  difference  of  almost  $2,  I  remember,  for  the 
cost  of  each  examination  made. 

Mr.  Newton.  What  did  you  say? 

Dr.  Stewart.  I  say  the  difference  in  the  organization  meant  a  difference  of  prac- 
tically $2,  the  difference  in  the  expense  of  the  examinations  made  in  the  tw©  organi- 
zations. 

The  Chairman.  You  mean  the  cost  per  capita? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  You  can  not  actually  figure  the  extent  of  the  organization? 

Dr.  Stewart.  No. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  169 

Mr.  Newton.  Were  all  of  the  members  of  this  organization  there  as  a  part  of  the 
Children's  Bureau? 

Dr.  Stewakt.  Yes. 

Mr.  Newton.  Both  physicians  and  social  workers? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  Just  what  time  were  you  there,  what  year,  and  when  did  you  com- 
mence, and  when  did  you  end? 

-  Dr.  Stewart.  1  think  possibly  June,  July,  and  August,  or  possibly  July,  August, 
and  September. 

Mr.  Newton.  Of  1918? 

Dr.  Stewart.  Of  1918. 

Mr.  Newton.  Just  what  general  work  was  conducted  there? 

Dr.  Stewart.  The  general  work — -there  were  a  great  many  people  that  I  have  not 
talked  about  at  all;  quite  a  large  body  of  social  workers  who  were  going  around  from 
house  to  house  in  order  to  complete  a  large  questionnaire  for  statistical  purposes. 

Mr.  Newton.  That  is  what  they  call  a  survey? 

Dr.  Stewart.  I  think  so;  that  is  what  they  call  it. 

Mr.  Newton.  Have  you  a  copy  of  that  questionnaire? 

Dr.  Stewart.  No;  not  with  me. 

Mr.  Newton.  And  they  were  at  work  on  that  all  of  the  time  you  were  there? 

Dr.  Stewart.  The  social  workers  were;  yes. 

Mr.  Newton.  Did  they  complete  the  work  in  three  months'  time? 

Dr.  Stewart.  No;  I  have  not  the  exact  time;  about  nine  months,  I  think,  or  pos- 
sibly longer.  Then,  I  understood,  there  were  a  hundred  or  more  social  workers  in 
Chicago  doing  desk  work,  compiling  statistics  from  the  Gary  survey.  I  understood 
it  was  necessarj'  to  do  this  work  in  the  field  instead  of  Washington  on  account  of  the 
appropriations. 

Mr.  Newton.  Just  what  work  was  done  by  the  physicians  on  the  staff  during  the 
three  months'  period? 

Dr.  Stewart.  They  were  examining  children  and  babies. 

Mr.  Newton.  Where  were  these  examinations  conducted,  in  different  places? 

Dr.  Stewart.  In  the  schoolrooms  and  in  halls. 

Mr.  Newton.  As  a  part  of  this  survey? 

Dr.  Stewart.  No;  not  as  a  part  of  the  survey.  That  was  not  to  complete  the  ques- 
tionnaire; I  just  mentioned  it  was  the  medical  work. 

Mr.  Newton.  It  was  in  conjunction  with  that  work? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  Now,  just  what  general  instructions  were  given  the  staff  of  physicians 
when  this  work  was  commenced  there?  What  I  am  trying  to  get  at  is  just  what  you 
were  told  would  be  the  duties  of  the  staff  of  physicians  while  you  were  there. 

Dr.  Stewart.  To  examine  the  children  and  babies,  and  gii^e  individual  instruction. 

Mr.  Newton.  You  mentioned  there  was  some  work  you  thought  should  have  been 
carried  on  that  you  were  not  permitted  to  carry  on;  that  is  correct,  is  it? 

Dr.  Stewart.  I  thought  it  was  unfortunate  that  the  doctors  did  not  have  an  oppor- 
tunity of  educating  the  public  through  the  papers  and  by  lectures,  as  we  had  done  in 
Fort  Worth,  Tex. 

Mr.  Newton.  You  mentioned  that  you  were  not  given  the  opportunity  to  give 
lectures,  and  no  instruction  in  vaccination,  or  the  giving  of  vaccination,  and  nothing 
along  the  line  of  pasteuri .nation  of  milk,  and  I  believe  one  or  two  other  things.  Were 
requests  to  carry  on  that  particular  work  made  to  the  person  in  charge  of  the  survey 
there  in  Gary? 

Dr.  Stewart.  That  is  just  my  own  opinion. 

Mr.  Newton.  That  was  your  own  opinion? 

Dr.  Stewart.  Yes. 

Mr.  Newton.  You  do  not  know  whether  that  was  discussed  at  all? 

Dr.  Stewart.  No;  I  do  not  know,  that  was  my  own  opinion,  although  other  physi- 
cians shared  in  the  opinion. 

Mr.  Newton.  You  do  not  know  of  any  reason  why  this  work  was  not  carried  on? 

Dr.  Stewart.  Well,  they  had  a  school  physician  in  Gary,  Ind.,  and  it  probably 
was  not  as  essential  in  Gary  as  it  was  in  Fort  Worth,  Tex.,  although  the  necessity  for 
the  education  of  the  children  was  even  more  necessary,  because  there  were  many 
foreign  children  and  very  ignorant  mothers. 

Mr.  Newton.  Is  it  your  judgment  as  a  physician  and  also  as  one  interested  in  the 
health  of  children  generally  that  the  work  there  among  the  children  was  handicapped 
by  the  fact  that  a  lay  person  was  in  general  charge  of  the  work  rather  than  a  medical 
person? 

Dr.  Stewart.  Very  much. 


170  PUBLIC  PEOTECTION   OF  MATEK]Sril:Y  AND  INFANCY. 

Mr.  Newton.  That  is  your  best  judgment,  that  the  work  was  very  much  handi- 
capped? 

Dr.  Stewart.  That  it  was  more  expensive  and  less  effective  in  the  way  of  educa- 
tion, because  it  was  not  carried  on  properly. 

Mr.  HocH.  I  would  like  to  have  my  mind  cleared  a  little  bit  as  to  the  governmental 
theory  on  which  the  two  classes  of  work  were  done.  I  understand  that  the  work  at 
Fort  Worth  was  done  because  there  was  a  cantonment  there — that  is,  the  work  entered 
into  by  the  Government  at  Fort  Worth  was  occasioned  by  the  presence  of  a  canton- 
ment there. 

Dr.  Stewart.  Yes. 

Mr.  HocH.  I  am  not  just  clear  as  to  what  the  relation  between  the  condition  of  the 
children  in  the  public  schools  at  Fort  Worth  has  to  the  fact  of  the  existence  of  an 
Army  camp  there. 

Dr.  Stewart.  The  primary  object,  of  course,  was  to  watch  out  for  any  contagious 
diseases,  and,  as  I  stated  before,  we  found  coTitagious  diseases  in  practically  all  the 
schools;  the  itch  was  very  prevalent,  and  it  got  into  the  camp  before  anybody  was 
aware  of  it.  We  found  scarlet  fever  and  smallpox — a  great  deal  of  it — and  trachoma. 
That  was  the  primary  object,  the  prevention  of  contagious  diseases  to  protect  the  boys. 

Mr.  HocH.  Now,  at  Gary,  as  I  understand,  that  work  was  conducted  as  a  matter 
of  survey  to  determine  certain  facts,  if  possible,  as  a  typical  community  of  that  sort? 
That  was  the  main  purpose  of  the  work  at  Gary,  was  it  not? 

Dr.  Stewart.  Well,  I  really  do  not  know  what  the  object  was. 

Mr.  HocH.  That  is  to  say,  the  Children's  Bureau  is  not  in  the  business  of  doing 
work  such  as  was  done  at  Gary  simply  for  the  results  to  be  obtained  in  that  particular 
community?     I  do  not  understand  that.     Do  you  understand  it  so? 

Dr.  Stewart.  It  was  very  surprising  to  me  when  I  went  up  to  Gary,  Ind.,  and 
found  that  the  doctors  and  nurses  were  doing  medical  work  for  the  Children's  Bureau, 
the  same  as  the  Public  Health  Ser\T.ce  was  doing. 

Mr.  HocH.  I  do  not  know  whether  I  made  myself  clear.  I  can  see  clearly  the 
theory  under  which  the  Government  did  the  work  at  Fort  Worth,  but  I  am  not  very 
clear  as  to  the  theory  under  which  the  Federal  Government  did  that  particular  work 
at  Gary,  unless  it  be  as  a  matter  of  experimentation,  a  matter  of  going  in  and  simply 
picking  Gary  as  a  community  of  certain  conditions  under  which  they  might  determine 
certain  facts  to  be  used  in  bulletins  for  general  dissemination.  Am  I  correct,  that 
that  is  the  theory  under  which  the  work  was  done  at  Gary? 

Dr.  Stewart.  I  think  you  would  have  to  ask  the  Children's  Bureau  about  that, 
because  I  never  did  know. 

Mr.  Mapes.  I  understand  that  you  are  connected  with  the  Public  Health  Serv- 
ice now? 

Dr.  Stewart.  Yes. 

Mr.  Mapes.  How  long  did  you  continue  with  the  Children's  Bureau? 

Dr.  Stewart.  Three  months. 

Mr.  Mapes.  I  understood  you  to  say  that  you  left  the  Public  Health  Service  tem- 
porarily after  doing  this  work  at  Fort  Worth,  with  the  approval  of  the  Public  Health 
SerAdce,  to  go  to  the  Children's  Bureau,  to  do  this  work  in  Gary? 

Dr.  Stewart.  Yes. 

Mr.  Mapes.  Was  there  any  particular  reason  for  your  doing  that? 

Dr.  Stewart.  Well,  it  was  my  personal  reasons.  I  had  an  opportimity  of  going 
home  on  the  way,  and  my  school  work  was  then  completed  at  Fort  Worth,  Tex.,  and 
they  could  get  along  without  me  as  soon  as  the  schools  closed.  The  chief  of  the 
Children's  Bureau  had  wired  me  three  times  asking  me  if  I  would  come  up  and  help 
them  temporarily. 

Mr.  Mapes.  Was  it  at  the  suggestion  of  anybody  in  the  Public  Health  Service  out- 
side of  yourself? 

Dr.  Stewart.  It  was  entirely  a  personal  reason  with  me.  I  was  rather  urged  to 
stay,  but  they  understood  my  personal  feelings  in  the  matter,  and  let  me  go. 

Mr.  Mapes.  It  was  a  matter  entirely  of  personal  convenience? 

Dr.  Stewart.  Yes. 

Mr.  Mapes.  Not  because  of  any  request  by  anybody  in  the  Public  Health  Service? 

Dr.  Stewart.  No.  I  think  the  chief  of  the  station  is  here.  He  could  answer  that. 
He  rather  urged  me.  to  change  my  mind,  but  at  the  same  time  understanding  my 
affairs  at  home,  and  that  my  husband  was  not  very  well,  he  let  me  go. 

Mr.  Barkley.  This  work  you  did  at  Fort  Worth  and  at  Gary  had  no  connection 
whatever  with  the  maternal  mortality  due  to  childbirth,  or  in  any  other  way  connected 
with  childbirth? 

Dr.  Stewart.  At  Fort  Worth? 

Mr.  Barkley.  Yes. 

Dr.  Stewart.  Except  as  I  examined  expectant  mothers. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  171 

Mr.  Barkley.  You  examined  everybody  to  see  if  there  was  any  contagious  disease 
down  there,  and  when  you  came  to  them  you  examined  them  all? 
^  Dr.  Stewart.  The  whole  station  had  cliar^f  of  the  extra  cantonment  work.     My 
own  work  especially  was  the  child  hy,t,deiK'  and  the  maternity  work. 

Mr.  Barkley.  Did  your  work  have  any  connection  with  the  disseminating  of  infor- 
mation or  the  obtaining  of  statistics  with  reference  to  maternal  mortality  due  to  child- 
birth? 

Dr.  Stewart.  We  obtained  statistics  and  sent  them  to  Washington  every  month. 

Mr.  Barkley.  But  that  was  not  the  primary  object  for  your  doing  that  work? 

Dr.  Stewart.  I  suppose  the  primary  object  for  having  the  work  done  in  Fort  Worth, 
Tex.,  was  on  account  of  the  city  being  an  extra  cantonment  zone,  but  I  was  told  that 
we  must  educate  every  mother  in  Fort  Wortih,  Tex.,  as  to  the  proper  care  of  her 
child,  and  that  was  my  work. 

Mr.  Barkley.  Was  any  educational  work  done  as  to  the  care  of  themselves  before 
the  birth  of  the  child? 

Dr.  Stewart.  That  was  done  through  individual  instruction  and  lectures  to  mothers 
only. 

Mr.  Barkley.  This  work  was  undertaken  by  the  Government  in  order  to  protect 
the  camp  down  there  to  prevent  any  outbreak? 

Dr.  Stewart.  That  was  the  primary  object  of  the  extra  cantonment  work. 

Mr.  Barkley.  And  that  work  was  divided  among  various  sections,  and  you  had  one 
section,  the  women  and  children,  and  other  physicians  had  the  other  sections  dealing 
with  other  kinds  of  people,  and  you  went  to  the  schools  and  took  the  whole  city  in? 
If  I  understand,  you  were  not  connected  with  the  Children's  Bureau  when  you  worked 
in  Gary? 

Dr.  Stewart.  I  was  connected  with  the  Children's  Bureau  when  I  worked  at  Gary. 

Mr.  Barkley.  You  were? 

Dr.  Stewart.  Yes. 

Mr.  B.XRKLEY.  The  three  months  you  were  with  the  Children's  Bureau  you  spent 
at  Fort  Worth  and  Gary ;  is  that  correct? 

Dr.  Stewart.  I  spent  three  months  with  the  Children's  Bureau  at  Gary. 

Mr.  T3arkley.  During  the  three  months  you  were  at  Gary  and  Fort  Worth? 

Dr.  Stewart.  During  the  three  months  I  was  at  Gary,  Ind.,  I  was  mth  the  Chil- 
dren's Bureau.  I  had  just  come  from  Fort  Worth,  Tex.,  and  had  completed  my  work 
at  Fort  Worth  for  the  Public  Health  Service. 

Mr.  Barkley.  Did  you  have  any  connection  with  the  Children's  Bureau  when  you 
were  in  Fort  Worth? 

Dr.  Stewart.  No;  none. 

^Ir.  Barkley.  I  misunderstood  you.     That  is  all. 

(Whereupon,  at  1  o'clock  p.  m.,  a  recess  was  taken  until  2  o'clock  p.  m.) 

AFTER   recess. 

The  committee  reassembled  at  2  o'clock  p.  m.,  pursuant  to  recess. 

The  Chairman.  Gentleman  of  the  committee,  if  you  will  kindly  come  to  order  we 
will  proceed  with  the  hearing.  We  have  Mr.  Eichelberger  before  us  this  afternoon, 
and  the  Chair  will  ask  him  to  make  a  statement  at  this  time.  Please  state  your  name 
and  pasition,  Mr.  Eichelberger. 

STATEMENT    OF    MR.    J.     S.     EICHELBERGER,    726     FOURTEENTH 
STREET,  WASHINGTON,  D.  C,  EDITOR  OF  THE  WOMAN  PATRIOT. 

Mr.  Eichelberger.  My  name  is  J.  S.  Eichelberger,  and  I  am  editor  of  a  publica- 
tion called  the  Woman  Patriot,  a  paper  published  in  Washington,  D.  C. 

Mr.  Chairman  and  gentlemen  of  the  committee.  I  want  to  try  t-o  make  it  clear  that 
I  personally  am  not  indifferent  to  this  suliject  of  the  protection  of  maternity  and  in- 
fancy. ]\Iy  mother  died  on  account  of  childbirth  with  her  tenth  child  when  I  was  a 
boy  of  three,  and  I  believe  that  she  had  the  same  doctor  all  the  way  through.  I  have 
known  other  similar  in.stances,  and  if  I  believed  that  this  bill  or  any  similar  bill  could 
reduce  maternal  or  infant  mortality  I  should  certainly  favor  it,  but  from  a  somewhat 
limited  study  of  the  bill,  and  the  nature  of  the  propaganda  behind  the  bill  and  what 
seems  to  be  "intended  to  be  done  under  the  bill,  I  believe  that  this  administration 
under  these  social  workers  would  actually  tend  to  increase  maternal  mortality. 

I  want  to  draw  the  attention  of  the  committee  to  an  article  published  in  the  Pictorial 
Review  of  February,  1921,  by  Florence  Kelly,  who  I  believe  is  general  secretary  of 
the  National  Consumers'  League.  This  article  is  entitled  'Mothers  and  Children 
Last,"  and  one  of  the  most  striking  statements  here  is,  "Millions  for  cattle,  sheep. 


I 


172  PUBLIC  PBOTECTION   OF  MATERNITY  AND  INFANCY. 

and  swine,  but  not  a  cent  for  the  20,P00  mothers  and  250,000  infants  who  die  pre- 
ventable deaths  every  year."  Then  in  a  note  it  says,  "It  is  safer  to  be  a  mother  in 
14  foreign  countries  than  in  the  United  Statev«,  and  babies  have  a  better' chance  in 
10  foreign  countries  than  in  our  own.  Congress  has  twice  been  deaf  to  the  cries  of 
dying  mothers  and  babies." 

Now,  gentlemen,  when  you  consider  the  fact  that  there  are,  in  round  numbers, 
2,500,000  children  born  every  year  in  this  country,  which  means  that,  in  round  num- 
bers, at  least  3,000,000  of  our  women  are  at  any  one  time  in  the  delicate  condition  of 
prospective  or  nursing  motherhood,  which  means  that  these  3,000,000  women  in  this 
delicate  condition  constitute  one-ninth  of  the  27,000,000  women  of  our  country,  what 
is  the  effect  of  such  propaganda  on  these  women?  Doctors  know,  and  I  think  that 
social  workers  at  least  ought  to  know,  that  this  frightfulness  and  terrorist  propaganda 
is  arousing  these  mothers  to  fear  and  dread  of  motherhood,  which  in  itself,  according 
to  some  physicians  who  have  talked  to  me  about  the  subject,  leads  to  certain  forms 
of  toxemia,  and  some  of  them  are  so  very  obscure  that  some  of  the  physicians  have 
been  arguing  ever  since  the  days  of  Semmelevis  as  to  just  what  has  happened  and  why. 

We  read  in  the  hearings  before  the  Committee  on  Public  Health  and  National 
Quarantine,  United  States  Senate,  May  1,  1920,  page  51,  a  statement  by  Mrs.  Kelly, 
the  author  of  this  article,  who  is  given  here  as  secretary  of  the  National  Consumers' 
League : 

"The  National  Consumers'  League  has  been  interested  for  several  years  in  the 
movement  for  compulsory  industrial  health  insurance  for  working  people.  We  have 
also  been  interested  in  legislation  providing  for  a  period  of  compulsory  rest  of  ex- 
pectant mothers  before  and  after  the  birth  of  their  children.  Both  of  these  measures 
are  vain  until  the  passgae  of  this  bill." 

The  rest  of  it  has  no  material  bearing  on  this  subject — well,  I  might  as  well  read 
the  rest  of  it — "because  it  is  a  most  cruel  kindness  to  take  woman  away  from  her  wage 
earning,  and  then  leave  her  without  medical  care  and  provision  before  and  at  the 
time  of  the  birth  of  her  child." 

So  we  see  that  the  idea  of  compulsory  health  insurance  comes  up  in  this  matter. 
As  a  matter  of  fact,  this  bill  is  modeled  on  maternity  benefit  systems  in  certain  foreign 
countries.  I  hold  in  my  hand  a  book  under  that  title  published  by  the  Children's 
Bureau.  In  the  letter  of  transmittal  of  this  book,  signed  by  the  chief  of  the  Children's 
Bureau,  it  is  said: 

"Maternity  benefit  systems  are  not  an  experiment.  *  *  *  Germany,  Austria- 
Hungary  early  established  such  systems,  and  Denmark,  Norway,  Rumania,  Russia, 
Serbia,  Sweden,  and  Switzerland  also  provided  maternity  benefits.  *  *  *  They 
vary  from  systems  under  which  every  woman,  regardless  of  her  financial  status,  re- 
ceives a  fixed  sum  on  the  birth  of  a  child,  to  sums  under  voluntary  insurance  funds, 
membership  in  which  is  only  to  wage-earning  women  in  certain  industries  and  receiv- 
ing certain  minimum  wages,  receive  subsidies  from  the  State." 

Now  notice  this  paragraph: 

"No  such  system,  once  undertaken,  has  ever  been  abandoned.  Instead,  the 
tendency  of  changes  in  existing  legislation  has  always  been  toward  including  larger 
and  larger  groups  of  the  population,  toward  increasing  benefits,  and  toward  a  com- 
pulsory as  contrasted  with  a  voluntary  principle  of  insurance." 

On  the  next  page  the  chief  of  the  Children's  Bureau  proceeds  to  say  that  this  docu- 
ment is  issued  "in  the  hope  that  the  information  might  prove  useful  to  the  people 
of  one  of  the  few  great  countries  which  as  yet  have  no  system  of  State  or  national 
assistance  in  maternity. ' ' 

Now,  as  we  look  over  this  book,  we  will  find  that  practically  all  of  these  maternity 
systems  are  part  and  parcel  of  compulsory  health  insurance  and  that  sort  of  socio- 
logical legislation.  There  are  several  countries  which  have  established  this  without 
these  features  of  compulsion.  New  Zealand  notably  has  its  entire  adnainistration 
voluntary,  and  according  to  this  book  itself  there  are  only  2  per  cent  of  the  people 
in  New  Zealand  who  subscribe  to  or  take  any  benefits  from  this  provident  fund,  to 
which  the  Government  contributes  in  part.  That  is  the  voluntary  system,  and  yet 
New  Zealand  has  the  lowest  infant  mortality  rate  in  the  world.  Australia,  in  prac- 
tically the  same  climate,  the  same  conditions,  has  a  mortality  rate  of  from  15  to  20 
points  higher  than  that  of  New  Zealand,  and  in  Australia  they  have  a  compulsory 
system  of  giving  a  sum  of  money,  $25  or  |30,  on  the  birth  of  each  child. 

On  page  12  of  this  book  it  says: 

''  The  list  of  countries  having  some  form  of  cash  benefit  for  mothers  diu-ing  maternity 
is  impressive." 

Also  on  page  13: 

"  One  of  the  most  humane  features  of  these  maternity  systems  is  the  treatinent  of 
the  unmarried  mother.     In  New  Zealand  only  is  she  excluded  from  the  aid."    Now 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  173 

note  that  fact.  "  In  New  Zealand  only  is  the  unmarried  mother  excluded  from  the 
aid" — and  also  that  New  Zealand  has  the  lowest  infant  mortality.  "As  in  most 
countries,  to  the  wage-earning  woman  who  is  protected  hy  the  insurance  system,  the 
maternity  benefit  is  practically  a  partial  suhstitute  for  wages.  The  usual  amount 
varies  from  50  to  75  per  cent  of  the  wages,  with  a  tendency  in  recent  laws  to  increase 
the  amount  to  either  full  wages  or  close  to  that  amount." 

Now  that  idea  of  cash  benefits  to  women,  or  free  medical  and  nursing  care  furnished 
by  the  State,  occurs  throughout  this  literature  of  the  Children's  Bureau.  I  have  not 
time  to  go  through  it  all,  but  I  \^  ill  read,  for  example,  the  latest  testimony  of  the  chief 
of  the  Children's  Bureau  in  that  regard.  This  is  on  April  25,  1921,  a  liearing  before 
the  Committee  on  Education  and  Labor: 

"  The  governments  of  Europe,  of  course,  have  been  for  a  long  time  much  more  con- 
cerned about  the  matter  of  infant  mortality  than  we  have,  and  at  the  present  time 
throughout  Europe  there  is  a  sense  of  necessity  which  we  do  not  feel,  and  while  the 
measures  adopted  may  seem  very  small  to  us,  it  has  been  a  fact  that  there  have  been 
maternity  benefits  given  throughout  the  countries  of  Europe.  Under  the  social 
insurance  of  England  there  have  been  maternity  benefits,  and  although  it  may  seem 
small  to  us,  it  allows  to  every  insured  man  and  woman  a  small  amount."    And  so  on  . 

I  now  wish  to  invite  the  committee's  attention  to  another  phase  of  this  subject. 
Here  is  a  book  gotten  out  by  the  New  York  Women's  Publishing  Co.,  which  is  the 
same  firm  that  publishes  the  Birth  Control  Review.  We  see  advertised  here  on 
the  one  hand  '"Endowment  of  Motherhood,"  on  the  other  hand  "Population  and 
Birth  Control,"  under  the  heading  of  "Books  on  Sex,  Feminism,  and  Birth  Control." 

In  this  Birth  Control  Review,  on  page  16  of  the  issue  of  February,  1921 — and  by 
the  way,  I  received  this  copy  of  the  Birth  Control  Review  at  the  recent  convention 
of  the  National  Woman's  Party — it  says: 

"In  November,  Mrs.  Sanger" — who  is  the  great  birth  control  advocate — "in  No- 
vember Mrs.  Sanger  spoke  to  the  League  of  Women  Voters  in  the  Fine  Arts  Guild . 
She  gave  several  lectures  in  the  Labor  Temple.  The  National  Woman's  Party 
arranged  the  meeting  for  Mrs.  Sanger  in  Washington.  *  *  *  From  Philadelphia 
Mrs.  Sanger  will  go  to  Reading,  Pa.',  where  she  had  a  most  successful  lecture  earlier 
in  the  ^\'inter,  and  her  return  was  urgently  asked  for  by  the  Visiting  Nurses' 
Association." 

I  just  quote  that  for  the  purpose  of  showing  how  these  things  dovetail  one  into  the 
other.     There  is  no  way  of  separating  them. 

We  note  here  in  the  October  number  of  the  Suffragist,  on  page  235,  October,  1920, 
that  Mrs.  Harriet  Stanton  Blatch,  who  is  the  daughter,  I  believe,  of  Elizabeth  Cady 
Stanton,  and  one  of  the  leaders  of  the  National  Women's  Party — and  also,  by  the  way, 
Socialist  candidate  for  comptroller  in  New  York  at  the  present  time — says — this  is 
under  the  title  of  "What  Next"— and  there  various  leaders  tell  what  they  are  going 
to  do  next,  and  then  it  says,  "And  behind  all  such  social  and  economic  demands 
lies  the  most  important  item  in  the  women's  program,  namely,  the  endowment  of 
motherhood.  Every  woman,  whether  the  wife  of  a  millionaire  or  a  day  laborer,  will 
in  the  world  builded  by  women  be  made  to  feel  that  society  honors  motherhood  suffi- 
ciently to  raise  it  aboye  all  sordid  dependence."  That  is,  the  dependence  of  the 
mother  on  the  father  of  her  child.  They  would  rather  have  her  dependent  on  the 
State. 

In  the  November  issue  of  the  same  organ,  the  Suffragist,  we  find  the  thing  somewhat 
frankly  stated  under  the  heading  "Wages  for  Mothers."  This  article,  "Wages  for 
Mothers,"  is  a  review  of  tliis  book,  "The  Endowment  of  Motherhood,"  which,  as  I 
have  already  shown,  is  published  by  the  same  company  that  gets  out  this  "Birth 
Control  Review,"  and  it  is  a  perfectly  interlocking  system  all  the  way  through.  It 
says  under  this  article,  "Wages  for  Mothers."     The  concrete  plan: 

"The  form  of  endowment  proposed  is  an  allowance  to  every  mother,  regardless  of 
income  level,  equivalent  to  the  difference  between  the  cost  of  maintaining  a  family 
and  the  cost  of  living  for  a  man  without  children.  Such  an  endowment  should,  ac- 
cording to  the  committee  " — now  the  committee  that  they  allude  to  is  the  committee 
which  gets  up  this  endowment  of  motherhood,  the  chairman  of  which  was  Miss  or 
Mrs. — it  doesn't  say  here — Kathleen  D.  Courtney,  formerly  secretary  of  the  British 
National  Union  of  Women's  Suffrage  Societies.     That  committee  recommended  that: 

"Such  endowment  should  be  extended  to  all  children  until  school-leaving  age, 
and  to  mothers  during  the  period  when  child  caring  is  or  should  be  a  full-time  occupa- 
tion." 

Under  the  heading  "How  Much  Will  Endowment  Cost,"  the  cost  of  such  endowment 
,  is  estimated — that  is  for  England — I  do  not  want  to  read  into  the  record  any  more  than 
I  have  to  of  this — 


174  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

"The  cost  of  such  endowment  is  estimated  at  about  £144,000,000  annually, ~or 
$720,000,000.  Such  figures  seem  low  compared  with  the  American  standards.  They 
are  low.  The  cost  for  the  United  States  with  its  higher  standards  and  its  larger 
population  would  be  much  greater  than  that  for  England.  The  United  States  can 
well  afford  to  invest  the  needed  billions  in  the  establishment  of  motherhood  upon  a 
sound  basis." 

Then  the  article  goes  on  to  tell  how  much  money  we  are  wasting  on  war,  and  so 
forth.  Here  again  in  the  Washington  Times  of  Wednesday,  October  13,  1920,  we  find 
an  article  entitled  "National  Endowment  of  Mothers  will  be  Woman  Voters'  Aim." 
It  is  an  article  by  Mildred  Morris,  of  the  International  News  Service,  and  she  quotes 
Miss  Helen  Todd,  of  New  York,  who  was  the  ofiicial  leading  speaker  for  the  New  Yokr 
State  Suffrage  Society  in  1915,  and  in  1917  was  chairman  of  the  greatest  birth  control 
meeting  held  in  New  York.  She  does  not  say  that  here;  that  is  my  description. 
Miss  Todd  says: 

"Place  the  mothers  on  the  Government  pay  roll  and  pay  them  the  money  that 
would  otherwise  be  spent  in  preparing  for  war.  The  general  fall  in  the  birth  rate  is 
a  matter  of  deep  concern  throughout  the  civilized  world.  The  average  young  couple 
Tinder  present  economic  handicaps  fear  to  risk  bringing  a  child  into  the  world.  Those 
who  lack  the  imagination  to  urge  national  endownment  of  motherhood  for  any  other 
reason  can  argue  for  it  on  the  ground  that  it  will  stimulate  the  Nation's  birth  rate." 

In  other  words,  Miss  Todd's  argument  is  that  the  mothers  will  not  have  children 
unless  you  pay  them  for  it  and  have  this  wages-for-mothers  scheme;  that  that  is  one 
of  the  justifications  for  it,  and  the  entire  tendency  of  this  legislation  is  in  that  direc- 
tion. As  the  chief  of  the  Children's  Bureau  tells  us  in  this  maternity  benefits  system, 
the  tendency  is  always  to  increase,  and  naturally  so,  because  if  the  State  takes  over 
the  care  of  maternity  and  infancy,  there  are  going  to  be  more  demands  as  the  people 
become  more  pauperized  by  this  care.  We  have  that  system  over  in  Russian  at  the 
present  time — and  by  the  way,  this  maternity  benefit  sustem  says,  on  page  175: 

"The  most  comprehensive  study  on  maternity  benefits  and  insurance  which  has 
yet  appeared  in  any  language  is  a  volume  by  Madame  A.  Kollontai."  Madame  Kol- 
iontai  is  the  Bolshevist  Commisar  of  Public  Welfare.  I  do  not  want  to  go  into  the 
Russian  situation  very  much,  because  it  would  occupy  the  time  of  this  committee 
to  a  great  extent,  and  it  has  already  been  covered  so  much  better  than  I  could  by 
certain  distinguished  Senators,  that  I  will  not  try  to  take  up  that  phase  of  it,  except 
this,  that  it  says  here  that  "The  section  on  Russia  is  now  of  historical  interest  only."^ 
The  reason  they  say  it  is  only  of  "historical  interest"  is  because  they  did  not  dare 
to  tell  the  American  people  what  had  happened  under  that  most  comprehensive 
Russian  system. 

Mr.  Denison.  Can  you  tell  us  what  did  happen,  briefly? 

Mr.  EiCHELBERGER.  I  would  rather  use  documents,  all  the  way  through. 

Mr.  Denison.  I  do  not  have  time  to  read  documents.  Can't  you  just  say  it  in  a 
few  sentences? 

Mr.  EiCHELBERGER.  We  have  several  documents  from  the  Russian  Information 
Bureau  in  the  United  States.  I  have  them  here,  and  I  would  refer  the  committee  to 
these  documents,  especially  this  article  on  "Children  in  Bolshevist  Russia,"'  as  a 
continuation  of  this  thing  which  was  of  historic  interest  only  to  the  person  who  com- 
piled this  book.  I  have  several  quotations  here  from  it.  Here  is  a  quotation  from 
that  article  by  Dr.  M.  Petroff.  He  declares  that  the  few  private  nurseries  left  in 
Petrograd  are  the  only  on-es  safe  for  children,  all  the  official  nurseries  having  become 
death  traps  under  incompetents.  He  quotes  the  superintendent  of  one  of  these  private 
nurseries,  the  Lesshaft  Nursery  in  Turgovia  Street,  25,  as  saying: 

"The  Russian  mother  is  now  living  through  a  deep  tragedy,  indeed.  Just  look  at 
the  women  you  pass  in  the  streets.  You  will  at  once  be  able  to  point  out  a  mother  of 
an  infant  among  them.  She  is  the  one  with  the  pale,  wan,  careworn  face.  You  can 
imagine  what  it  means,  the  Soviet  Government  insistently  demanding  that  the 
mother  turn  over  her  little  children  to  the  official  nursery  when  you  have  seen  for 
yourself  what  a  horror  they  are,  and  they  are  such  horrors  because  they  have  been 
entrusted  to  people  who  do  not  love  that  work  and  who  are  perfect  strangers  to  it. 
As  a  matter  of  fact,  the  death  rate  among  the  nursery  children  is  appalling.  To  send 
your  child  there  is  almost  certain  death." 

Dr.  Petroff  cites  the  mortality  of  children  to  have  increased  from  81  per  10,000 
inhabitants  in  1913  to  372  in  1919  and  419  in  1920  in  Moscow,  and  the  births  having 
decreased  from  54,000  in  1913  to  23,000  in  1920. 

Now,  when  you  adopt  this  propaganda  of  f rightfulness  to  these  women,  when  you 
preach  a  program  which  tells  the  mothers  that  they  ought  to  get  on  the  Government 
pay  roll,  when  you  tell  them  that  Congress  has  refused  to  hear  the  cries  of  dying 


PUBLIC   PROTECTION   OF   MATERISTITY  AND  INFANCY.  175 

mothers  and  children,  what  do  yon  do?  You  reduce  your  birth  rate,  and  that  is 
what  is  happening  in  this  country  to-day.  Here  in  ''  Hirth  Statistics, "  issued  hy  the 
Census  Bureau,  is  this  statement:  ''The  birth  rate,  22.3  per  thousand  population  for 
the  birth  registration  area  in  1919,  is  the  lowest  for  any  year  since  1915,  when  this 
area  was  established.  Every  State  shows  a  decrease  in  the  f)irth  rate  as  compared 
with  1918,  the  greatest  decrease  being  for  Utah.  Notwithstanding  this  decrease, 
Utah  has  the  highest  rate,  while  California  has  the  loM'est,  a  difference  of  12.5." 

Now,  Mr.  Chairman,  it  has  been  said  before  this  committee  that  the  United  States 
stands  far  down  in  the  list  for  both  infant  mortality  and  maternal  mortality.  One  of 
the  physicians  who  appeared  here  on  b(fhaif  of  the  bill,  from  New  York,  described 
the  work  in  New  York  as  a  great  examph?  of  what  could  be  done  under  this  bill.  I 
say  that  whatever  credit  thf^re  is  for  the  New  York  work  should  go  to  New  York  and 
the  State  administration  of  this  l)ill — or,  rather,  this  system. 

I  hold  in  my  hand  here  a  summary  of  rate  tables  for  infant  mortality.  I  have  gone 
through  this  and  marked  in  red  ink  the  rates  of  various  States  and  cities  throughout 
the  Union,  which  are  all  lower  than  New  York.  Every  one  of  them  is  lower,  and  in 
infant  mortality  you  will  find  by  an  examination  of, page  31  of  this  Birth  Statistics 
that  the  United  States  has  a  lower  rate  than  any  other  great  foreign  country,  and  our 
rate,  of  course,  comes  a  good  deal  from  the  fact  that  in  certain  sections  of  our  country 
and  among  certain  races  of  people  the  mortality  is  very  high,  but  under  similar  con- 
ditions our  rates  compare  favorably  with  the  lowest  in  the  world.  For  example,  in 
Pasadena,  Cali(.,  the  rate  is  exactly  the  same  as  in  New  Zealand,  45.  In  Beverly, 
Mass.,  it  is  48,  while  the  next  foreign  rate  which  compares  in  any  way  with  that  is 
Norway,  which  has  a  rate  of  60.  Now,  Australia  has  a  rate  of  69.2,  whereas  in  Spo- 
kane, Wash.,  we  have  a  rate  of  55;  Brookline,  Mass.,  53;  St.  Paul,  Minn.,  68;  Wash- 
ington, D.  C.  (white),  67;  San  Francisco,  Calif.,  62;  State  of  Washington,  63;  Green- 
ville, S.  C.  (white),  61;  State  of  Oregon,  63;  Raleigh,  N.  C.  (white),  63;  StateofMinne- 
sota,  67;  State  of  California,  70;  State  of  Kansas,"70;  State  of  New  York,  84;  State  of 
Massachusetts,  88. 

The  highest  American  rate  for  any  State  is  South  Carolina,  which  has  a  rate  of  113, 
but  the  white  rate  in  South  Carolina  is  76,  or  considerably  below  the  average,  so  that 
there  they  have  a  peculiar  problem.  But  in  Germany,  in  Austria  and  Rus.sia,  which 
early  established  these  systems  of  compulsory  health  insurance  and  maternal  benefits, 
they  have  rates  of  155  for  Germany;  Austria,  190;  and  Russia,  250. 

There  is  what  is  called  a  brief  for  the  maternity  bill,  which  is  published  on  page  7  of 
the  hearings  before  the  Committee  on  Public  Health  and  National  Quarantine.  That 
is  the  first  hearing.  This  brief  has  also  been  put  out  as  a  publicity  statement  by  the 
Children's  Bureau.  I  had  a  copy  of  it  sent  to  our  paper,  which  I  happened  to  lend  to 
a  Senator.     It  says: 

"The  United  States  is  wasting  the  lives  of  mothers  and  babies.  In  1918  some  23,000 
mothers  died  in  childbirth  and  nearly  a  quarter  of  a  million  babies  died  under  one  year 
of  age.  Most  of  these  deaths  are  preventable.  Other  countries  show  markedly 
lower  death  rates  of  babies  and  mothers  in  childbirth.  It  is  safer  to  be  a  mother  in 
14  important  foreign  countries  than  in  the  United  States,  and  babies  have  a  better 
chance  in  7  foreign  countries  than  here  in  our  own  country.  Infant  deaths  from 
maternity  causes  are  not  decreasing,  because  mothers  do  not  yet  have  the  skilled  care 
:and  advice  that  they  need." 

Now,  as  I  understand  this  bill  it  does  not  provide  for  skilled  care  and  advice;  it 
Iprovides- — this  bill  which  is  before  this  committee — provides  for  popular,  nontechnical 
instruction  to  the  residents  of  the  various  States. 

I  Now,  in  justice  to  the  proponents  of  this  bill  I  want  to  say  that  they  have  in  the 
'Senate  committee,  after  very  much  criticism,  taken  out  the  words  "popular  non- 
technical," and  let  it  read  just  to  provide  instruction.  But  in  a  similar  case  they 
'took  out  the  clause  which  provided  for  medical  or  nursing  care.  In  the  old  bill 
Iwhich  was  before  it  the  Senate  amended  this.  They  called  that  medical  and  nursing 
;care  the  heart  of  the  bill;  and,  Mr.  Chairman,  I  would  like  to  observe  at  this  point  the 
Itestimony  of  Dr.  Josephine  Baker,  of  New  York,  that  her  child  hygiene  station  did 
JQOt  give  medical  and  nursing  care;  they  merely  gave  prenatal  instructions;  whereas 
jthis  bill  contemplated  medical  and  nursing  care.  That  was  in  it,  but  when  that  bill 
iwas  criticized  to  a  certain  extent  in  the  Senate  they  took  out  the  words  "medical  and 
laursing  care,"  the  same  as  they  took  out  this  nontechnical  and  popular  instruction, 
'but  it  did  not  do  any  good,  because  that  is  a  blanket  enactment;  you  can  do  prac- 
tically anything  under  this  bill.     The  first  section  reads: 

"For  the  purpose  of  cooperating  with  the  States  in  promoting  the  care  of  maternity 
*nd  infancy." 

Now  the' Senate  has  cut  out  everything  else  in  there  except,  "as  hereinafter  pro- 
vided."   The  "hereinafter  provided  "  is  over  in  section  8: 


176  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

'  'That  any  State  desiring  to  avail  itself  of  the  benefits  of  this  act  shall  by  its  agency 
described  in  section  4,  submit  to  the  Children's  Bureau  for  its  approval  detailed  plans 
for  carrying  out  the  provisions  of  this  act.  These  plans  shall  include  the  provisions 
to  be  made  in  the  State  for  the  administration  of  the  act,  the  provision  of  instruction 
in  the  hygiene  of  maternity  and  infancy  through  public  health  nurses,  consultation 
centers,  and  other  suitable  methods." 

Now  where  is  your  limitation  of  power  in  this  bill?  They  can  still  provide  non- 
technical advice;  they  can  still  provide  medical  and  nursing  care;  they  can  pvit  that 
in  their  I'equirements,  and  in  section  3  the  chief  of  the  Children's  Bureau  is  m-ade 
executive  officer,  and  while  she  is  directed  to  form  an  advisory  committee  to  consult 
with  the  chief  of  the  Children's  Bureau,  to  advise  concerning  any  problems,  there  is 
nothing  in  the  bill  which  compels  the  chief  of  the  Children's  Bureau  to  take  any- 
body's advice. 

In  the  same  action  it  says  that  the  Children's  Bureau  shall  have  charge  of  all  matters 
concerning  the  administration  of  this  act  and  shall  have  power  to  cooperate  with 
the  State  agencies,  etc.,  and  it  shall  be  the  duty  of  the  Children's  Bureau  to  make  or 
cause  to  be  made  such  studies,  investigations,  and  reports  as  will  promote  the  efficient 
administration  of  this  act. 

Now,  Mr.  Chairman,  and  gentlemen  of  the  committee,  I  wish  to  show  just  one  very 
loose  clause  in  this  bill,  a  very  dangerous  clause,  in  section  9: 

"The  State  agency  described  in  section  4  is  authorized  to  arrange  with  any  educa- 
tional institution  for  the  provision  of  extension  courses  by  qualif  ed  lectures." 

It  does  not  say  that  she  is  authorized,  or  he,  or  whoever  this  State  agent  may  be — 
that  they  are  authorized  to  arrange  with  certain  educational  institutions  of  certain  defi- 
nite standing,  butany  educationalinstitution.  In  other  words,  25  per  cent  of  the  funds 
under  this  bill  in  the  State  of  Illinois  could  be  spent  on  instructors  from  Hull  House, 
an  institution  of  social  workers — any  educational  institution.  There  are  practically 
no  limitations  to  this  bill,  and  the  only  thing  that  they  say  in  reply  to  all  charges  is, 
"Well,  do  you  believe  that  these  people  will  do  this?"  Now  we  have  their  own 
testimony  as  to  what  they  will  do. 

' '  Income  and  infant  mortality, ' '  a  leaflet  issued  by  the  Children's  Bureau  and  signed 
by  the  chief  says: 

"None  of  the  studies  made  by  the  bureau  attempts  to  approach  infant  mortality 
as  a  medical  question.  They  are  concerned  with  the  economic,  social,  civic,  and  family 
conditions  surrounding  young  babies,  etc.  The  surroundings  of  each  child  are  traced 
through  the  first  year  of  life,  or  such  shorter  period  as  he  survived,  by  women  agents 
of  the  bureau  who  called  upon  each  mother  and  obtained  the  information  through 
direct  personal  interviews.  *  *  *  Now  it  was  plainly  necessary  to  accept  a 
mother's  statement  Vvdth  reference  to  matters  directly  pertaining  to  the  daily  life  of  a 
baby,  it  was  thought  that  she  might  not  always  know  about  her  husband's  earnings, 
and  other  sources  of  information  might  be  more  important;  hence  in  one  of  the  earliest 
studies  a  test  was  made  of  the  accuracy  of  the  mother's  answers  to  the  income  questions 
by  comparing  them  with  facts  about  the  father's  earnings  collected  from  as  many 
sources  as  possible.  Pay  rolls  were  consulted  and  employers  and  fathers  themselves 
were  interviewed." 

Now  under  the  act  creating  the  Children's  Bureau  it  said  that  they  could  not  do 
that  over  the  objection  of  the  parents.  Of  course  there  is  very  little  objection.  There 
is  testimony  in  thislast  hearing  by  Mrs.  McNanamy  that  some  of  these  agents  pushed 
by  her  and  her  niece,  I  believe,  and  examined  the  baby  that  was  in  a  bathtub,  and  told, 
them  that  they  came  from  the  Government  and  that  they  had  a  right  to  do  it,  and  of 
course  the  poor  woman  did  not  know  anvthing  about  the  law. 

They  have  issued  a  book  here  called  ' '  The  Status  of  State  Bureaus  of  Child  Hygiene, ' ' 
and  I  beg  to  invite  the  attention  of  the  committee  to  the  fact  that  there  are  34  of  those 
different  bureaus  in  operation  right  now,  and  it  says: 

"  It  is  interesting  in  passing  to  note  that  though  public  health  measures  are  so  largely 
educational  in  character,  these  State  child  welfare  divisions,  with  three  exceptions, 
have  been  established  under  State  boards  of  health.  The  exceptions  being  Colorado , 
New  Mexico,  and  Utah,  and  these  divisions  are  under  departments  of  education." 

So  that  there  is  not  in  the  United  States  a  single  one  of  these  departments  under  a 
department  of  labor  or  a  sociological  board. 

Mr.  Lea.  What  is  the  publication  you  just  referred  to? 

Mr.  EiCHELBERGER.  TMs  is  "The  Status  of  State  Bureaus  of  Child  Hygiene."  It 
is  by  Anna  E.  Rude,  M.  D.,  Director  of  the  Division  of  Hygiene  of  the  United  StatesJ 
Children's  Bureau.     It  is  the  Children's  Bureau  report  on  the  State  activities,  and  it] 
says  here:  ' 

"In  this  country,  as  in  foreign  countries,  the  history  of  the  child  welfare  movement; 
shows  that  philanthropic  and  voluntary  efforts  have  initiated  the  work  which  serve^ 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  177 

as  a  demonstration  and  have  quite  logically  been  taken  over  eventually  by  local 
authorities." 

Now,  Mr.  Chairman,  I  want  to  say  in  conclusion  that  the  question  of  the  State 
taking  charge  of  the  needy — that  has  always  been  done.  Throughout  all  history,  I 
believe,  society  has  tried  to  take  care  of  the  needy,  the  people  who  can  not  support 
themselves  and  so  on,  but  this  bill  in  section  10  applies  to  all  residents.  Practically 
anything  can  be  done  under  it.  It  tends  to  pauperize  the  people;  it  tends  to  make 
tile  mothers  believe  that  Uncle  Sam,  instead  of  their  own  husbands,  ought  to  take 
care  of  them.  This  "wages  for  mothers"  propaganda  and  this  compulsory  health 
insurance — and  of  course  there  is  another  propaganda  back  of  this,  and  that  is  the 
industrial  life  insurance  companies  are  also  interested  in  compulsory  health  insurance 
for  working  people,  so  that  they  ^^'ill  not  need  any  agents.  I  think  that  is  a  very 
short-sighted  policy,  because  I  believe  that  the  Government,  if  it  goes  that  far,  will 
go  further  and  take  over  the  insurance  business  itself.  But  I  have  a  clipping  here 
from  the  Fall  River,  Mass.,  Daily  News  of  Monday,  October  18, 1920,  called  "  Financing 
Maternity,"  and  I  offer  that  clipping  and  such  extracts  as  the  chairman  may  care  to 
make  from  it  in  regard  to  the  people  that  are  financing  this  vast  propaganda,  as  I  be- 
lieve it  is,  which  has  the  greatest  effect,  not  in  preventing  infant  mortality  or  maternal 
mortality,  but  in  scaring  women  out  of  ever  becoming  mothers. 

The  Chairman.  Does  any  member  of  the  committee  desire  to  ask  any  questions? 

Mr.  Newton.  In  connection  with  that  extract  you  have  just  submitted,  does  it 
give  the  proof  or  the  authority  for  the  statement  as  to  who  is  back  of  this  propaganda? 

Mr.  EiCHELBERGER.  I  do  not  believe  that  it  does,  Mr.  Newton. 

Mr.  Newton.  Of  coiu'se  that  is  quite  importaM.  It  is  very  easy  for  anybody,  you 
know,  to  come  out  in  the  press  or  on  the  floor  of  Congress,  or  any  other  place,  and  make 
I  the  general  charge  that  a  certain  group  of  people  or  certain  interests  are  behind  a 
certain  measure,  but  it  really  does  not  carry  much  weight  unless  there  is  some  sub- 
stantiation of  it. 

Mr.  EiCHELBERGER.  I  think  that  throughout  this  testimony,  if  the  gentleman  will 
allow  me,  you  ^vill  find  allusions  constantly  to  the  reports  issued  by  Mr.  Dublin,  of 
the  Metropolitan  Life  Insiu-ance  Co.,  in  regard  to  this.  The  book  of  the  Children's 
Bureau,  Maternity  Benefit  Systems  in  Certain  Foreign  Countries,  in  a  way  advertises 
the  book  on  ^laternity  Insurance,  by  Mr.  Leo  Frankel,  who  is  the  vice  president  of  the 
Metropolitan  Life  Insurance  Co.,  and  I  think  that  those  people  in  all  fairness  should 
be  asked  to  testify  for  themselves  as  to  what  they  are  doing  along  this  Une. 

It  has  already  occurred  in  the  testimony  of  Dr.  Van  Ingen  that  these  people  were 
very  closely  associated  with  the  Maternity  Center  Association  at  New  York,  and 
according  to  Collier's  of  April  30,  1921,  Mr.  Frankel  says  that  the  comj^any  estimates 
that  they  are  spending  $1,500,000  a  year  for  welfare  work.  That  is,  in  keeping  its 
policyholders  healthy,  and  that  in  doing  so  it  kept  18,000  people  on  the  face  of  the  earth 
during  1919  who  would  otherwise  have  been  under  it,  and  also  saved  itself  more  than 
$3,000,000  in  death  claims. 

Of  coiu'se,  I  have  no  objection  whatever  to  insurance  companies  or  industrial  insur- 
ance or  anything  of  that  sort,  but  I  absolutely  subscribe  to  the  sentiments  of  the  editor 
of  the  Daily  News  that  those  companies  should  not  attempt  to  get  the  Government 
to  take  over  their  ^'isiting  nui-ses  and  their  expenses  of  soliciting,  etc.,  by  passing 
compulsory  insurance  laws,  and  yet  leave  them  their  profits  of  the  insurance  business. 

Mr.  Newton.  Now  you  mentioned  compulsory  health  insurance.  Is  there  any 
provision  in  this  particular  bill  that  is  before  us  about  compulsory  health  insiuance? 

Mr.  EiCHELBERGER.  There  is  no  provision  in  this  bill,  Mr.  Newton,  not  one,  but  it 
might  be  in  the  standards  required.  I  see  nothing  to  prevent  it.  I  see  nothing  any- 
where in  this  bill  to  prevent  that  some  one  of  the  standards  should  require  it. 

Now  we  do  not  have  to  imagine  all  the  standards.  We  have  a  whole  book  here  called 
"The  Standards  of  Child  Welfare,"  which  was  gotten  up  by  a  committee  composed,  I 
believe,  mostly  of  foreigners  who  were  in\ited  here  by  the  Children's  Biu-eau  to  prac- 
tically legislate  for  the  people  of  the  United  States. 

Mr.  Newton.  Well,  I  can  not  agree  with  you  as  to  that.  Is  there  anything  about 
cash  benefits  in  this  bill? 

Mr.  EiCHELBERGER.  No,  sir;  it  is  a  blanket  bill  which  merely  gives  them  power  to 
do  practically  all  things  for  the  care  of  maternity  and  infancy. 

Mr.  Newton.  Is  there  anything  about  birth  control  in  it? 

Mr.  EiCHELBERGER.  Not  exccpt  that  other  matters  and  related  subjects  etc.,  are 
there.  It  is  all  vague  and  indefinite.  We  do  not  know  what  these  qualified  lec- 
turers are  going  to  be.  So  far  as  mere  qualification  is  concerned,  I  believe  that  Miss 
Helen  Todd  and  Mrs.  Margaret  Sanger  would  qualify  as  lecturers  under  this  bill,  as 
well  as  anybody. 

74654—21 12 


178  PUBLIC  PROTECTION   OF   MATERNITY  AND   INFANCY. 

Mr.  Newton.  You  do  not  know  of  anything  in  the  bill  that  requires  them  to  be 
appointed  as  lecturers? 

Mr.  EiCHELBBRGER.  Oh,  that  requires  no  particular  individual  women. 
Mr.  Newton.  Does  it  require  Margaret  Sanger  or  Miss  Todd  or  any  other  faddist? 
Mr.  ErcHELBERGER.  Of  course  there  is  nothing  in  the  bill  providing  for  the  appoint- 
ment of  any  particular  woman,  so  far  as  I  know,  on  those  committees,  but  I  beg  to 
invite  the  gentleman's  attention  to  the  fact  that  even  the  local  and  State  committees 
are  recommended  from  this  central  office  of  the  Children's  Bureau,  and  while  it  says 
that  such  advisory  committee  shall  be  selected  by  the  State  agencies,  it  also  says  that 
the  Children's  Bureau  may  recommend  to  the  State  agencies  the  appointment  of  these 
committees,  and  so  forth,  and  in  actual  practice  the  Children's  Bm-eau,  having  the 
money,  can  practically  assert  that  here  and  say,  "You  want  to  put  on  your  advisory 
committee  in  your  State  So-and-so,  and  then  we  will  O.  K.  your  plan." 

Mr.  Newton.  You  are  afraid  that  as  a  necessary  consequence  the  administrative 
body  here  at  Washington  will  either  appoint  Margaret  Sanger  or  a  like  person  upon 
the  boards  or  will  require  some  State  agency  to  do  likewise. 

Mr.  EiCHBLBERGER.  That  is  not  precisely  my  point.  I  do  not  know  whether,  after 
all  this  publicity,  and  so  forth,  Mrs.  Sanger  or  Miss  Helen  Todd  would  have  much  of  a 
chance  of  getting  in  on  this  bill  right  away,  but  there  are  others.  My  objection  is  to  the 
blanket  power  conveyed  in  this  bill  to  do  practically  anything  that  one  person,  how- 
ever sincere — and  the  more  sincere  they  are  the  more  dangerous  they  are,  absolutely — 
to  do  practically  anything  toward  providing  the  care  of  maternity  and  infancy  that 
may  in  that  person's  judgment  seem  good. 

Mr.  Newton.  Then  you  have  stated,  I  believe,  that  you  are  in  favor  of  doing  work 
contemplated,  fairly  contemplated,  under  this  bill  in  order  to  encourage  better  pre- 
natal care  and  better  care  of  babies — the  general  proposition.  Did  I  understand  you 
correctly? 

Mr.  ErcHELBERGER.  I  am  in  favor  of  the  work  that  is  going  on  under  these  State 
bodies  of  health  along  these  lines  which,  as  Dr.  Baker  pointed  out,  is  confined  by  the 
States  to  preventive  work  the  same  as  all  public  health  work.  They  do  not  take  care 
of  people  in  sickness  unless  it  is  the  case  of  an  epidemic. 

Mr.  Newton.  All  right.  Now,  do  you  object  to  the  Federal  Government  stimulat- 
ing interest  in  that  particular  field? 

Mr.  EiCHELBERGER.  I  tMuk  the  Federal  Government  does  and  should  stimulate 
that  interest.     I  have  seen,  for  example — I  think  we  probably  have  them  here — here 
are  a  whole  series  of  bulletins  which  are  gotten  out  by  the  Public  Health  Service,  a 
series  of  articles  prepared  especially  for  newspapers. 
Mr.  Newton.  And  you  approve  of  that,  do  you? 
Mr.  EiCHELBERGER.  I  approve  of  that  work. 

Mr.  Newton.  You  were  in  the  committee  room  this  morning  and  heard  the  testi- 
mony of  Dr.  Stewart,  I  believe,  of  the  Public  Health  Service? 
Mr.  EiCHELBERGER.  Yes,  sir. 

Mr.  Newton.  Of  the  work  that  was  undertaken  under  her  supervision  down  there 
at  Fort  Worth.  Do  you  approve  of  activities  of  that  kind  by  the  Federal  Govern- 
ment? 

Mr.  EiCHELBERGER.  Why,  I  think  the  activity  which  she  specifically  covered  in 
that  case  was  absolutely  a  function  of  the  Federal  Government  on  account  of  the  camps, 
etc.,  and  this  general  preventive  and  sanitary  work  of  the  health  department,  I  of 
course  approve  of. 

Mr.  Newton.  Then  would  you  have  objection  to  the  work  contemplated  by  this 
bill  if  it  was  placed  under  the  Public  Health  Service  rather  than  under  the  Children's 
Bureau? 

Mr.  EiCHELBERGER.  I  would  object  to  such  a  blanket  enactment  as  this  bill,  and 
to  the  principle  of  subsidy,  whether  it  was  under  the  one  or  the  other. 

Mr.  Newton.  You  mean  the  principle  of  subsidy,  that  is,  of  money  grants  to  the 
States? 

Mr.  EiCHELBERGER.  Yos,  because  1  do  not  believe  that  there  is  any  way  of  working 
out  that  subsidy  without  injustice  either  to  the  States  or  to  the  Federal  Government. 
Somebody  has  got  to  be  in  control  of  that  money.  If  you  give  it  to  the  States  uncon- 
ditionally they  spend  it  as  they  please,  and  if  you  give  it  to  them  conditionally,  you 
control  their  expenditures,  not  only  of  that  part  of  the  funds,  but  by  compelling 
certain  standards  you  more  or  less  control  their  own  appropriations. 

Mr.  Newton.  So  that,  on  account  of  that,  you  are  against  the  entire  principle  of 
Federal  aid  in  any  way  furthering  this  work?     Do  I  understand  you  correctly? 

Mr.  EiCHELBERGER.  By  that  sort  of  a  subsidy.  But,  Mr.  Newton,  I  believe  that 
of  the  two  evils  the  lesser  is  that  which  is  contemplated  under  the  Moses  amendment 
in  the  Senate,  Now  the  Moses  amendment  in  the  Senate  grants  a  subsidy  for  the 
establishment  of  local  county  hospitals.     Then  it  provides  that  if  one  of  these  local 


PUBLIC  PROTECTION  OF  MATERNITY  AND  INFANCY.  179 

cdunty  hospitals  is  not  abiding  by  the  standards  of  the  State  health  boards,  that  the 
Slate  health  board  can  write  in  here  to  the  Surgeon  General,  etc.,  and  prevent  that 
county  from  getting  its  Federal  money.  But,  of  course,  political  conditions  being 
as  they  are,  I  believe  there  would  be  a  very  remote  possibility  of  any  State  board  of 
health  certifying  against  any  particular  county  getting  Federal  money  unless  the 
(•iiri(litions  there  were  positively  outrageous  and  caused  a  scream  to  Ileaven  and  the 
Slate  Medical  Society  and  everybody  else  demanded  that  that  county  be  penalized. 
That  is  the  only  way  I  see  in  which  we  can  safely  work  out  this  subsiay  and  preserve 
nur  independent  State  system. 

Mr.  Newton.  This  paper  that  you  are  editor  of,  the  Woman  Patriot,  that  is  the 
ollicial  organ,  is  it,  of  the  association  opposed  to  suffrage  for  women? 

Mr.  EicHELBERGER.  Ycs,  Mr.  Newton.  And  in  that  connection  I  would  like  to 
make  a  statement. 

'I'he  Chairman.  Pardon  me.  I  dislike  very  much  to  hold  you  down,  but  if  you 
MJII  confine  your  answers  to  the  questions  it  will  give  some  other  witness  a  chance 
t(i  ,<,'et  on  this  afternoon. 

Mr.  Newton.  You  made  some  remark  here  during  the  fore  part  of  your  talk  in 
reference  to' the  benefits  under  this  act  being  available  to  the  unmarried  mother, 
i  )n  I  get  you  correctly  that  you  oppose  the  passage  of  a  bill  of  this  kind ;  that  you  are 
oi)]):ised  to  the  uimaarried  mother  getting  any  of  the  benefits  of  this  act? 

Mr.  EicHELBERGER.  I  oppose  anything  which  tends  in  the  direction  of  promoting 
that  (Condition. 

Mr.  Newton.  So  do  we  all  oppose  that,  but  do  you  think  that  the  rendering  of  care, 
prenatal  care,  to  the  unfortunate  woman  who  expects  to  become  a  mother — that  that 
would  encourage  that  condition  among  others? 

Mr.  EicHELBERGER.  It  would  encourage  it  if  it  were  applied  from  a  distant  bureau 
in  such  a  way  as  to  relieve  the  unmarried  mother  of  the  natural  moral  factor,  which 
even  the  Socialists  admit,  of  facing  her  own  family  and  her  own  community,  and 
all  that  sort  of  thing,  that  naturally  tends  to  prevent  the  advent  of  these  poor  little 
fatherless  children.  Of  course,  where  such  a  state  exists,  either  through  philanthropic 
agencies  or  other  local  agencies  that  particular  case  has  to  be  handled. 

Mr.  Newton.  Yes;  both  the  mother  and  the  child  are  entitled  to  the  utmost  care. 

Mr.  EicHELBERGER.  Surcly. 

Mr.  Newton.  Is  not  that  the  proper  position? 

Mr.  EicHELBERGER.  Surcly. 

Mr.  Newton.  That  being  the  case,  I  can  see  where  the  grant  of  a  mother's  endow- 
ment indiscriminately  might  encourage  that;  but  you  do  not  maintain  that  anything 
in  this  bill  is  susceptible  of  any  such  interpretation,  do  you? 

Mr.  EicHELBERGER.  That  there  is  an  endowment  embodied  in  it? 

Mr.  Newton.  Yes. 

Mr.  EICHELBERGER.  I  Say  that  the  same  propaganda  behind  this  bill  goes  to  that 
and  absolutely  considers  it. 

Mr.  Newton.  As  a  matter  of  fact,  is  not  this  statement  of  yours  in  reference  to  the 
fear  of  increasing  the  number  of  unmarried  mothers — ^is  that  not  about  on  a  par  with 
the  statements  of  some  of  the  proponents  of  legislation  of  this  kind  going  to  the  other 
extreme?  Is  that  not  about  what  you  would  get  in  the  extreme  suffragist  papers,  or 
some  birth-control  re\iew,  or  some  other  paper  of  like  sort?  Haven't  you  gone  to 
one  extreme  just  as  they  have  gone  to  the  other? 

Mr.  EicHELBERGER.  I  hardly  think  so,  Mr.  Newton.  I  have  taken  their  own  docu- 
ments. I  have  not  drawn  any  particular  conclusions  from  them  except  those  that 
I  have  read  to  the  committee  and  gone  over. 

The  Chairman.  Are  there  any  other  questions  to  ask  the  witness?  If  not,  we  will 
excuse  you,  Mr.  Eichelberger,  and  thank  you  for  your  testimony. 

The  next  witness  to  be  heard  will  be  Miss  Kilbreth. 

STATEMENT  OF  MISS  MARY  G.  KILBRETH,  SOUTH  HAMPTON,  LONG 
ISLAND,  N.  Y.,  REPRESENTING  THE  NATIONAL  ASSOCIATION 
OPPOSED  TO  WOMAN  SUFFRAGE. 

Miss  Kilbreth.  Mr.  Chairman  and  gentlemen,  it  is  perfectly  evident  what  interests 
the  committee  in  this  bill.  It  is  the  medical  aspect  of  the  bill,  the  care  of  expectant 
mothers  and  children,  that  is  carr>ing  it  along  with  this  enormous  propaganda  and 
that  is  also  interesting  the  public,  just  as  it  interests  the  committee. 

Now,  we  are  told  by  the  Children's  Bureau  itself,  and  in  the  committee  hearings, 
and  in  various  pul)lications,  that  this  is  not  a  health  matter;  consequently,  as  we 
wanted  to  understand  this  bill  we  felt  it  was  a  health  matter  and  we  could  not  see 
any  other  aspect  to  it.    What  we  imdertook  to  do  was  to  study  the  publications  of  the 


180  PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY. 

organization  from  which  this  bill  emanated  and  in  whose  hands  it  would  be  placed 
to  administer,  in  order  to  find  out  really  by  thoroughly  studying  this  bill  what  was 
proposed.  If  it  was  not  a  health  measure,  then  what  was  it?  Now,  that  was  certainly 
legitimate.  That  is  our  interest  in  the  Children's  Bureau  in  this  connection,  conse- 
quently, we  got  this  pile  of  literature  and  found  that  there  was  a  pile  that  high  [indi- 
cating] of  sociological  writings,  almost  entirely  drawn  from  other  countries,  published 
at  great  expense,  containing  the  illegitimacy  laws  of  Norway — there  was  everything 
under  the  sun  in  those  books,  and  a  little  pile  of  actual  health  books  about  that  high 
[indicating]. 

Even  the  health  books  I  object  to — I  mean  as  not  of  any  special  use  to  these  women. 
For  instance,  I  compare  them  with  the  Health  Department  publications.  Here  is  a 
book — these  are  supposed  to  go,  I  suppose,  very  largely  to  women  who  can  not  employ 
fine  physicians  and  do  not  have  attendant  nurses  and  all  that  sort  of  thing.  In  other 
words,  they  are  supposed  to  be  popular  publications,  are  they  not?     They  must  be. 

Here  is  one  of  the  most  important  subjects.  This  is  a  book  published  by  the 
Children's  Bureau  entitled  "What  is  Malnutrition?"  Now,  what  in  the  name  of 
common  sense  does  the  average  woman  expect — the  woman  with  children  or  with  a 
young  child,  presumably  not  particularly  well  placed  in  life — what  does  she  care 
about  what  is  malnutrition?  What  that  woman  wants  to  know  is  how, to  feed  her 
baby,  doesn't  she?     She  doesn't  care  anything  about  what  is  malnutrition. 

Now,  the  only  value  in  putting  me  on  the  stand  is  that  I  am  simply  a  commonplace 
woman,  not  an  expert,  but  I  am  a  voter  and  a  citizen,  and  I  have  a  certain  right  to 
my  beliefs.  Here  is  this  Feeding  for  Babies,  Bottle  Feeding  for  Babies,  Breast  Feed- 
ing for  Babies,  Infant  Mortality — the  most  simple  things  that  any  woman  that  is  a 
day  laborer  can  understand  perfectly. 

Now,  here  are  all  these  leaflets  by  the  Health  Department  [indicating].  Senator 
King  made  a  great  point  of  all  this  on  the  Senate  floor.  These  are  publications,  very 
simple  articles,  to  be  put  in  the  newspapers.  These  come  from  the  Health  Depart- 
ment. There  is  not  a  particle  of  propaganda  in  that.  All  that  the  Health  Department 
is  doing  is  getting  out  simple  information  for  women,  the  only  kind  of  simple  informa- 
tion that  ought  to  be  given  by  anybody  but  her  own  personal  attendant  physicain, 
as  Mrs.  Putnam  pointed  out,  I  think,  this  morning.     I  think  I  understood  her. 

Now,  here  is  this  list  [indicating];  here  are  all  these  little  simple  articles,  short, 
brief,  extremely  concise  and  simple,  and  here  they  all  are.  They  go  into  the  country 
newspapers  and  everywhere.  You  know  how  the  country  woman  reads  her  news- 
paper, reads  every  inch  of  it,  and  the  husband  does  the  same. 

Against  that  you  have  got  What  is  Malnutrition?  and  Maternity  Benefits  in  Foreign 
Countries,  and  all  the  rest  of  it — Standards  of  Child  Welfare.  Now  these' standards 
were  set  up  by  a  number  of  foreign  physicians — here  they  are  [indicating] .  You  all 
have  the  publication,  I  suppose — and  all  of  these  men  were  brought  here  to  help  set 
up  these  standards.  They  were  from  Czechoslovakia,  some  of  them,  and  they  were 
from  Japan — from  everywhere  under  the  sun,  and  at  the  bottom  it  says  that  there 
were  not  very  many  American  physicians  invited,  because  the  housing  conditions 
were  bad,  and  they  could  not  get  many  Americans;  consequently,  this  book,  which  is 
called  Standards  of  Child  Welfare,  is  largely  drawn  up  by  visiting  foreign  physicians 
who  came  here  in  "more  or  less  panicky  condition"  from  the  war  area  in  Europe. 
These  standards  were  set  up,  not  from  the  advice  of  men  taken  from  normal  conditions, 
but  the  advice  of  men  who  had  just  come  from  those  horrible  ravaged  countries  of  war. 

Mr.  Barkley.  Is  that  the  result  of  a  sort  of  world  conference  held  in  this  country 
on  child  hygiene? 

Miss  KiLBRETH.  That  was  arranged  by — I  think — -will  you  ask  the  question  again, 
please? 

Mr.  Barkley.  I  wanted  to  know  whether  that  pamphlet  that  you  have  there  was 
the  result  of  deliberations  of  the  world  child  conference  held  in  the  United  States? 

Miss  KiLBRETH.  I  dou't  kuow  whether  you  would  call  it  the  world  child  conference; 
this  is  the  Children's  Bureau  conference  that  was  called  here  in  Washington. 

Mr.  Barkley.  It  was  participated  in,  then,  by  delegates  from  various  nations  who 
were  invited  here  by  the  United  States  Government? 

Miss  KiLBRETH.  I  dou't  Understand  by  the  United  States  Government.  No; 
by  the  Children's  Bureau. 

Mr.  Barkley.  They  were  invited  here  by  an  agency  of  the  United  States  Gov- 
ernment. 

Miss  KiLBRETH.  I  did  not  know  that.     It  says  here,  "  By  the  Children's  Bureau. " 

Mr.  Barkley.  Well^^  that  is  an  agency  of  the  Government. 

Miss  KiLBRETH.  Yes ;  but  it  does  not  make  any  difference ;  my  point  is  that  the  stand- 
ards came  from  foreigners. 

Mr.  Barkley.  Some  very  distinguished  Americans  participated  in  that  congress. 
did  they  not? 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  181 

Miss  KiL»RKTH.  Yes,  sir. 

Mr.  Barkley.  So  it  is  not  entirely  a  foreign  document. 

Miss  KiMJUETH.  I  did  not  mean  to  say  entirely  for('if;;n,  hut  they  outnumbered  the 
Americans,  l)ecau8e  wo  are  told  distinctl\'  they  did  not  have  many  American  experts 
here  on  account  of  the  difficulty  in  housing  conditions.  Washington  was  so  crowded, 
That  is  their  own  statement,  page  8.  Here  it  is  in  the  book.  If  you  wish  to  see  it  I 
will  be  glad  to  have  you  look  at  it. 

Now  we  are  told  that  this  thing  is  not  a  health  measure;  we  are  told  that  it  is  social 
and  economic.  I  want  to  point  out,  if  you  please,  that  it  is  also  political.  This  bill 
is  riddled  with  politics.  It  was  the  football  of  politics  at  the  last  two  conventionfl  of 
the  great  political  parties. 

Mr.  Johnson.  I  did  not  understand  you  there. 

Miss  KiLBRETH.  I  say  that  the  Children's  Bureau  says  that  this  is  not  primarily  a 
health  measure,  hut  is  a  social  and  economic  measure.  I  wish  to  talk  on  the  social  and 
economic  side  in  just  a  moment  but  I  want  to  add  to  that  description  that  it  is  also  a 
political  measure.  One  of  the  fiercest  fights  in  the  two  conventions  was  over  this  bill. 
At  the  two  national  conventions,  this  was  the  first  demand  in  the  program  ol  the 
National  League  of  Women  Voters,  the  organization  which  is  chiefiy  pushing  this.  I 
am  very  much  interested  in  this  political  aspect.  It  is  germane  from  my  point  of 
view,  because  as  an  American  citizen  I  believe  in  representative  government  and  I 
believe  that  the  national  platform  of  a  political  party  is  a  contract  with  the  people 
and  that  the  people  have  a  right  to  look  to  the  party  in  power,  whom  they  elect,  to 
cany  out  that  contract. 

In  addition  to  that,  I  wish  to  call  ^  our  attention  to  the  fact  that  women,  as  well  as 
men,  voted  at  this  election,  the  first  general  election  at  which  women  have  ever  voted. 
So  that  you  can  not  say  this  is  an  expression  of  refusal  on  the  part  only  of  the  oppressive 
man.  A  great  welfare  program  was  presented  at  both  conventions.  So  far  as  I  can 
discover  from  following  both  conventions  and  being  in  communication  with  certain 
of  the  political  leaders  in  each,  it  was  the  same  non-partisan  lobby  or  delegation. 
There  were  the  same  leaders  in  both.  The  first  demand  in  the  program  was  this  child 
welfare.  This  is  the  official  statement  they  put  out  [indicating].  Now  I  think  that 
is  very  important — the  struggle  in  the  two  committees,  the  subcommittee,  and  the 
policies  and  platform  committee,  if  that  is  what  you  call  it. 

Mr.  Newton.  You  mean  in  the  Republican  convention? 

Miss  KiLBRETH.  Yes,  I  am  interested  in  the  Republicans,  because  the  Republicans 
are  now  in  control  of  legislation  and  are  responsible  for  what  is  done. 

Here  is  the  report  of  subcommittees.  I  will  leave  this  book  so  that  the  committee 
can  look  it  over.     Here  is  "Protection  of  maternity." 

"Activities  in  this  and  other  countries  for  mothers'  protection."  And  then  it  goes 
into  social  insurance;  they  are  practically  all  the  same  thing.  There  are  old  age 
pensions,  etc.     The  significant  thing  about  this  is  that  this  subcommittee 

Mr.  Newton.  May  1  interrupt  you  there?  These  that  you  refer  to  are  the  sugges- 
tions that  came  to  the  subcommittee  from  this  large  committee  that  Will  Hays  ap- 
pointed? 

Miss  KiLBRETH.  I  am  coming  to  the  other  committees.  I  am  coming  to  the  platform 
committee  in  a  minute.  This  is  the  social  problems  subcommittee  that  had  to  do  with 
what  you  call  "welfare  legislation." 

Mr.  Newton.  Yes;  there  was  such  a  committee. 

Miss  KiLBRETH.  There  was  that  committee.  They  were  not  men  of  the  same 
importance  that  were  on  the  national  one  at  all.  Now,  what  I  want  to  emphasize  is 
that  that  committee  handed  over  every  one  of  these,  acceded  to  every  one  of  these 
demands.  Every  one  without  exception  was  reported  favorably.  Then  it  went  to 
the  big  platform  committee  and  every  one  of  them  was  killed. 

The  struggle  over  those  bills  was  tremendous.  Now  the  men  in  charge  of  making 
the  general  Republican  platform  were  not  political  dreamers;  they  were  men  who  were 
trying  to  make  a  ])latform.  Without  criticizing  them  in  any  way,  they  were  trying 
to  make  a  platform  that  would  win,  and  they  were  trying  to  make  the  platform  that 
the  peojile  would  accept  at  the  polls  and  they  believed  that  the  people  were  tired  of 
paternalism  and  all  the  rest  of  this,  and  they  put  out  the  platform  absolutely  free  from 
that.  If  you  are  interested  I  have  that  platform,  and  it  is  significant  as  compared 
with  the  Democratic  platform. 

Mr.  Barkley.  The  Republican  platform,  I  believe,  contained  no  reference  to  this 
subject. 

iliss  KiLBRETH.  Absolutely  not.     If  you  say,  I  will  read  it  to  you. 

Mr.  Barkley.  Do  you  think  that  the  party  that  is  in  power  is  bound  by  wh 
does  not  say,  as  well  as  what  it  does  say? 


182  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Miss  KiLBRETH.  I  do  not  think  at  all  that  the  representative  is  the  slave  of  the 
people  on  every  subject,  but  I  think  that  when  there  is  an  issue  before  two  national 
conventions  and  one  convention  puts  in  the  entire  program — this  bill  specifically  is 
in  the  Democratic  program — and  the  other  party  refuses  even  to  mention  it,  then 
I  think  it  is  a  mandate,  it  is  a  contract  with  the  successful  party  to  carry  out  its  position. 
What  the  voters  did  was  to  vote  on  the  two  great  platforms.  There  is  no  qestion  of 
that.  And  they  put  the  Republicans  in  absolute  control  of  legislation.  There  has 
never  been  any  such  control  of  legislation  as  the  Republicans  now  have. 

Mr.  Barkley.  How  do  you  explain  the  fact  that  one  of  the  first  bills  recommended 
by  President  Harding  is  this  maternity  bill? 

Miss  KiLBRETH.  I  want  to  take  that  up.  And  first  I  want  to  read  his  speech  of  ac- 
ceptance. It  is  very  important.  I  consider  that  the  essential  part  of  constitutional 
government  is  that  it  should  be  representative;  the  people  should  not  be  overridden. 
This  is  what  President  Harding  says  in  his  speech  of  acceptance: 

"Our  first  commitment  is  the  restoration  of  representative  popular  government 
under  the  constitution,  through  the  agency  of  the  Republican  Party. " 

Then  he  goes  on  and  mentions  various  visions  which  he  has  of  the  future,  and  then 
he  says  that  these  representatives  come  here  fresh  from  the  peoples 

Mr.  HuDDLESTON.  Did  the  President  in  that  speech  refer  to  this  class  of  legislation? 

Miss  KiLBRETH.  He  does  in  the  social  welfare  speech — the  social  justice  speech. 

Mr.  HuDDLESTON.  What  did  he  say  about  it? 

Miss  KiLBRETH.  The  social  justice  speech  was  made  just  before  election.  A  delega- 
tion of  women  went  to  him  at  that  time  and  this  is  what  he  said 

Mr.  Johnson  (interposing).  May  I  ask  how  many  speeches  he  made  on  the  same 
subject. 

Miss  KiLBRETH.  I  cau  not  tell  you. 

Mr.  Johnson.  He  sometimes  changed  his  mind. 

Miss  KiLBRETH.  He  says — that  is  quite  a  long  speech;  I  will  leave  it  with  the  com,- 
mittee,  but  this  is  probably  the  essential  part: 

' '  I  pledge  myself  to-day  to  support  with  all  that  is  in  me  whatever  practical  policy 
of  social  welfare  and  social  justice  can  be  brought  forward  by  the  combined  wisdom 
of  all  Americans.  Nothing  can  concern  America  and  nothing  can  concern  Tae  as  an 
American  more  deeply  than  the  health,  the  happiness,  and  the  enlightenment  of 
every  fellow  American. " 

That  isn't  very  specific.  Then  he  goes  on  under  the  heading  "Departanent  of 
public  welfare,  "  and  says: 

"There  can  be  no  more  efficient  way  of  advancing  a  humanitarian  program  than  by 
adopting  the  machinery  of  our  .Federal  Government  to  the  purposes  we  desire  to  at- 
tain. While  others  may  have  their  eyes  fixed  upon  some  particular  piece  of  legisla- 
tion"  

Mr.  HuDDLESTON  (iuterposing) .  I  am  anxious  for  you  to  read  the  particular  part 
that  you  consider  refers  to  this  legislation. 

Miss  KiLBRETH  (reading:) 

"While  others  may  have  their  eyes  fixed  upon  some  particular  piece  of  legislation  or 
some  particular  policy  of  social  justice  which  calls  for  the  sympathetic  interest  of  us 
all,  I  say,  without  hesitation,  that  our  primary  consideration  must  be  the  machinery 
of  administration' ' — well,  that  is  not  very  specific,  is  it?     [Reading.] 

"Let  us  not  only  have  social  justice  and  social  welfare  developed  to  the  fullest 
extent  which  a  wise  citizenship  will  approve,  but  let  us  have  also  the  means  with 
which  to  make  social  justice  and  social  welfare  real  and  functioning  rather  than 
visionary  and  inefficient." 

Mr.  HuDDLESTON.  I  don't  get  anything  out  of  that  which  indorses  this  legislation. 

Miss  KiLBRETH.  It  is  all  welfare  legislation.  Now  just  let  me  read  one  more  para- 
graph.    The  President-elect  himself  was  worried  about  this,  because  he  says: 

"I  recognize  certain  dangers  which  are  always  presented  when  government  under- 
takes large  and  detailed  tasks.  I  have  said  already  to-day  that  we  must  avoid  pater- 
nalism, and  that  we  must  avoid  it  because  a  paternalistic  social  welfare  program  would 
smother  some  of  the  liberties,  some  of  the  dignity,  and  some  of  the  freedom  for  self- 
expression  of  our  individuals." 

And  so  forth.  It  is  not  so  much  any  one  thing  he  says  about  this  bill,  but  the  whole 
thing.     Oh,  yes,  he  says  here  "Protection  of  maternity."     [Reading:] 

"We  all  know  that  we  face  tasks  of  social  justice  which  we  must  undertake  with 
-dispatch  and  efficiency.  Who  can  suggest  one  of  these  tasks  which  can  supersede  in 
our  hearts,  or  in  the  rank  which  foresight  and  wisdom  will  give,  that  of  the  protection 
of  maternity?" 

Now  in  his  opening  message  to  Congress  he  said  he  assumed  that  Congress  would 
pass  thm  bill. 


PUBLIC  PROTECTION-   OF   MATERNITY  AND  INFANCY.  183 

]\rr.  IIuDDLESTON.  ITo  Said  that  he  was  in  favor  of  this  kind  of  legislation? 

Miss  KiLBHETH.  Absolutely • 

Mr.  HuDDLESTON-.  T)o  you  accept  that  as  a  promise  on  the  part  of  the  President  as  to 
what  he  would  do  if  ho  were  elected? 

Miss  KiLBRETH.  I  think  he  considered  it  a  promise.  It  was  considered  by  the 
women. 

Mr.  HuDDLESTON.  Do  you  accept  it  as  a  promise  on  behalf  of  his  party? 

Miss  KiLBUETH.  He  had  no  power  to  do  that. 

Mr.  HuDDLESTON.  IIo  was  the  candidate  of  the  party  and  he  spoke  its  principles. 
He  had  the  power  to  commit  it  to  that  policy,  did  he  not? 

Miss  KiLBRETH.  No;  certainly  not.  He  is  very  explicit.  One  of  the  things  that 
determined  the  election  was  that  there  should  be  no  more  administrative  interference. 

Mr.  HunoLESTON.  May  I  ask  how  you  think  the  President  could  carry  out  the 
policy  he  advocated  except  through  the  legislative  branch  of  the  Government? 

Miss  KiLBRETH.  I  did  not  mention  the  President.  I  have  not  mentioned  the 
President. 

Mr.  HuDPLESTON.  How  did  the  President  promise  that?  Did  he  not  promise  that 
he  would  use  his  influence  with  the  legislative  branch,  or  that  his  party  would  advo- 
cate through  the  legislative  branch  such  measures  along  that  line  that  would  make 
that  promise  a  li\ang  thing?    The  President  was  not  "bluffing"  the  people. 

Miss  KiLBRETH.  No;  I  think  it  was  a  humanitarian  statement.  Now  the  only  thing 
I  know  of  where  there  was  any  such  statement  as  you  refer  to  was  in  the  message  to 
Congress  where  he  said  "I  assume  that  Congress  will  pass  this  legislation."  I  know 
of  nothing  else. 

Mr.  HuDDLESTON.  That  was  a  polite  way  of  asking  it,  was  it  not? 

Miss  KiLBRETH.  I  can  not  interpret  it.     You  can  interpret  that  as  well  as  I  can. 

Mr.  HuDPLESTON.  I  referred  to  the  subject  matter  because  of  the  fact  that  your 
argument  seems  to  imply  that  the  party  in  power  is  not  in  any  way  committed  on  this 
legislation. 

Miss  KiLBRETH.  I  feel  that  it  is  absolutely  not  committed. 

Mr.  HuDDLESTON.  I  am  wondering  how  you  can  reach  that  conclusion  despite  these 
commitments  of  the  leader,  the  spokesman,  and  the  head  of  the  party. 

Miss  KiLBRETH.  I  feel  that  the  platform  is  the  party  law.  I  feel  that  the  national 
platform  is  party  law  until  the  next  national  platform  is  framed.  This  is  not  a  govern- 
ment by  an  indi\'idual  autocrat  in  the  White  House.  That  platform  is  what  was  voted 
upon  by  the  people;  it  was  given  out  as  a  pledge.  The  two  parties  in  their  platform 
were  diametrically  opposed  to  each  other  on  this  bill. 

Mr.  HuDDLESTON.  I  wili  ask  j^ou,  Do  you  think  that  any  individual  voter  in  the 
United  States  knew  all  that  was  in  either  of  the  party  platforms? 

Miss  KiLBRETH.  I  Can  say  very  definitely  this:  I  know  the  struggle  that  went  on 
over  those  special  bills,  and  the  Republican  platform  was  not  paternalistic. 

Mr.  HuDDLESTON.  You  think  it  won  just  on  that  general  idea,  then? 

Miss  KiLBRETH.  Absolutely.  I  do  not  mean  that  every  voter  knew  every  one  of 
these  bills;  I  am  saying  the  party  leaders  knew  them. 

Mr.  HuDDLE.STON.  I  am  wondering  whether  you  would  imagine  that  as  much  as 
10  per  cent  of  the  voters  could  have  substantially  quoted  any  plank  in  any  of  the 
platforms? 

Miss  KiLBRETH.  They  wanted  to  get  away  from  governmental  interference.  In 
the  great  Republican  procession  that  took  place  in  New  York  every  group  of  men  and 
women  had  their  own  signs,  and  the  one  that  aroused  furors  that  went  all  up  the 
avenue  from  one  end  of  it  to  the  other  was  "Less  government  in  business  and  more 
business  in  government."     If  they 

The  Chairman.  I  think  I  would  like  to  ask  Mr.  Huddleston  if  he  would  take  a 
minute  or  two  to  discuss  the  pertinency  of  this  discussion  that  is  going  on. 

Mr.  HuDDLE.STON.  I  am  listening  only. 

Miss  KiLBRETH.  All  that  I  wanted  to  say  was  that  I  do  not  consider  that  this  bill 
should  ])e  up  now.  The  people  disposed  of  it  at  the  election.  I  think  it  is  a  t>T)ical 
l)ill.     If  this  goes  through,  representative  government  breaks  down. 

In  all  the  discussions  in  the  Senate — the  discussions  were  amazing  in  the  Senate 
on  this  sul)ject.     One  Senator  after  another  said,  "This  legislation  is  going  through." 

Mr.  Newton.  You  mean  this  discussion  last  winter? 

Miss  KiLBRETH.  Ycs;  last  December — December  16,  17,  18.  Here  is  the  Record- 
The  different  leaders  [indicating].  One  after  another  of  those  men  said  in  sul)stance 
"I  am  not  prepared  to  say  whether  I  approve  of  this  or  not.  but  it  is  going  through." 

Now.  of  course  we  do  not  like  that  kind  of  thing  right  after  a  campaign  where  thi.i 
was  an  issue  and  where  the  party  that  was  against  it  was  put  in  absolute  control. 


184  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Another  thing  that  I  want  to  speak  of  in  connection  with  this  legislation  is  what 
you  might  call  "left-wing  legislation."  In  the  Lusk  committee  report  in  New  York, 
which  has  just  been  published  in  New  York — the  most  comprehensive  thing  on 
Socialism  that  there  is,  I  suppose,  they  claim  the  way  the  Socialist  Party  is  making 
headway  all  over  the  world  is  through  boring  into  different  organizations.  Now,  by 
"Socialist,"  I  do  not  mean  the  mild  Socialist,  what  they  call  the  "White"  Socialist; 
I  am  talking  about  the  Red  Communist.  Every  party,  every  church,  practically 
every  organization,  has  its  left  wing.  The  Republicans  have  their  left  wing.  They 
have  Raymond  Robbins  and  Boyce  Thompson,  etc.  The  Democrats  have  their 
Herron,  Creel,  etc.  Now,  there  isn't  an  organization  that  hasn't  its  left  wing.  The 
churches  have  them.  The  Episcopal  Church  in  New  York;  even  the  Catholic  Church 
has  them.     There  is  a  violent  radical  in  the  Unitarian  Church  in  New  York. 

Now,  this  legislation  was  proposed  to  the  President  by  Mrs.  Raymond  Robins. 
Mrs.  Raymond  Robins 's  sister,  Mrs.  Dreier,  of  Brooklyn,  has  been  over  and  over 
again  at  legislative  hearings,  and  I  have  seen  her.  Mrs.  Florence  Kelly,  who  is 
backing  this  bill  to  the  utmost,  was  so  violent  on  the  floor  on  the  New  York  Legislature 
in  speaking  before  a  committee  there — I  was  not  10  feet  away  from  her — that  the 
chairman  said,  "Madam,  if  you  are  advocating  strikes,  this  is  not  the  place  to  do  it," 
etc.  This  is  absolutely,  to  my  mind,  left-wing  legislation.  I  am  not  at  all  criticising 
the  women  who  appear  as  advocating  this  bill,  because  I  do  not  think  it  is  ever  the 
policy  of  the  left-wing  people  to  put  the  real  promoters  at  the  head  of  a  movement 
that  would  give  it  away.  I  think  the  manipulation  is  always  behind,  and  I  would 
like  very  much  to  know  how  much  control  Hull  House  would  have  in  the  adminis- 
tration of  this  bill  if  it  passes.  I  would  like  very  much  to  know  how  much  control 
other  organizations  that  are  very  close  would  have  in  this.  I  do  not  know  how  much 
they  would  have. 

The  Chairman.  Miss  Kilbreth,  I  think  that  unless  you  are  prepared  to  draw  a  line 
of  positive  connection  between  your  ideas  and  the  people  you  refer  to,  you  ought  not 
to  inject  that  sort  of  testimony  into  the  hearing.  The  chairman  will  have  to  ask  you 
if  you  will  not  confine  yourself  to  a  statement  of  ideas  on  the  bill,  or  definite  demon- 
strations of  a  possible  connection  between  elements  which  you  think  are  reprehensible. 

Miss  Kilbreth.  As  to  this  making  the  woman  and  child  independent,  lifting  the 
responsibility  of  the  woman  and  child  off  the  man  and  putting  it  on  society,  that  of 
course  is  very  definitely  in  the  present  Socia,list  platform.     They  say  it  must  be  done. 

Now,  I  think  the  chief  objective  of  all  these  I.  W.  W.  and  all  that  sort  of  thing  is 
the  Labor  Party.  The  Labor  Party  has  been  the  greatest  obstacle  in  the  way  of  the 
advance  of  these  red  movements  in  the  United  States.  It  has  resisted  them  in  a  very 
remarkable  way.     In  England  it  has  not  resisted  them. 

Here  is  an  English  book  Endowment  of  Motherhood.  In  that  they  say  boldly  that 
if  you  are  ever  to  have  socialization  of  industry  you  will  have  to  have  a  system  of 
maternal  benefits,  which  is  advocated  in  the  Children's  Bureau.  You  must  have 
some  form  of  "benefits"  to  lift  the  burden  of  the  woman  and  child  off  the  man  and 
leave  him  free  and  unhampered  in  the  economic  struggle.  Now  the  Labor  Party  in 
the  United  States  does  not  favor  socialization  of  industry.  The  English  are  more 
radical.     Here  is  what  the  Socialist  platform  says  cautiously: 

"The  Socialist  Party  does  not  seek  to  interfere  with  the  institution  of  the  family  as 
such,  but  promises  to  make  family  life  fuller,  nobler,  and  happier  by  removing  the 
sordid  factor  of  economic  dependence  of  woman  and  man  and  by  assuring  to  all  mem- 
bers of  the  family  greater  material  security  and  more  leisure  to  cultivate  the  joys  of 
the  home." 

But  it  means  the  same  thing;  only  it  is  presented  in  a  different  form._  The  Labor 
Party  would  not  accept  that,  yet  some  of  them  are  advocating  this  sort  of  thing.  I 
think  they  are  fooled,  just  as  women  and  a  great  many  people  are  fooled,  as  to  where 
this  legislation  is  leading. 

All  this  material  which  is  published  by  the  Children's  Bureau  is  the  most  extreme 
socialistic  legislation.  They  indorse  the  Russian,  Madam  Kollontai's  system,  and 
they  indorsed  all  that. 

Mr.  Barkley.  What  is  that  you  say  the  Children's  Bureau  indorses? 

Miss  Kilbreth.  They  said  her  book  is  the  most  comprehensive  system.  They 
published,  you  know,  in  their  pamphlet,  this  reference  to  Madam  Kollontai. 

Mr.  Barkley.  What  system  is  that? 

Miss  Kilbreth.  Madam  Kollontai's  system  in  Russia — a  system  of  maternal  bene- 
fits— takes  charge  of  all  the  children,  etc.  She  is  called  "commissair  of  public  wel- 
fare." 

Mr.  Barkley.  When  was  this  published? 

Miss  Kilbreth.  This  book  was  pubhshed  in  1917,  I  think — no,  1919 — but  the  point 
was  that  this  Madam  Kollontai  held  her  position  under  the  Czar.  She  was  in  the  pay 
of  the  German  General  Staff  at  the  time. 


J 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY,  185 

Mr.  Barki.ky.  Is  there  any  invidious  clcduction  to  be  drawn  from  the  fart  that  the 
Children's  Bureau  found  somebody  in  Russia  who  knew  something  about  this  and 
recommended  it. 

Miss  Kilbiji;th.  This  woman  was  in  the  pay  of  the  German  Government  for  some- 
time under  the  Czar,  accordino:  to  documents  issued  by  our  State  Department.  She 
was  one  of  th(^  marked  people  there. 

Mr.  H.\uKi.EY.  Do  you  object  to  her,  then,  just  because  she  was  a  spy,  and  not  be- 
cause she  did  not  know  anythins^  about  it? 

Miss  KiLTJUETH.  I  object  to  her  socialistic  scheme  of  maternal  benefits.  Here  are 
books  tellina;  about  it,  together  with  a  translation  of  the  Russian  systems  under  her. 
She  is  now  head  of  the  people's  commissiarat  of  social  welfare.  She  was  formerly,  I 
believe,  head  of  the  bureau  of  public  welfare. 

In  soviet-Russia  interested  parties  may  appeal  from  the  local  bureau  of  social  welfare 
to  the  people's  commissariat  of  social  welfare,  Madam  KoUontai  chief,  just  as  in  section 
12  of  the  Sheppard-Towner  bill  a  State  may  appeal  from  the  rulings  of  the  Children's 
lUiroau  to  the  Secretary  of  Labor  in  the  same  department.  But  in  Russia  interested 
parties  have  the  right  to  contest  a  ruling  even  of  Madam  Kollontai  "in  the  manner 
laid  down  by  any  ordinary  civil  action."  Russians  have  legal  redress.  This  is  the 
Soviet  Law  of  Marriage  and  the  Family,  translated  in  Contemporary  Review,  April, 
1920. 

Mr.  Barkley.  Legal  redress  against  what? 

Miss  IviLBRETH.  Against  the  ruling  of  the  head  of  a  department. 

Mr.  Barkley.  What  is  there  in  this  bill  that  is  compulsory  or  that  would  bring 
about  any  condition  from  which  any  individual  would  have  to  appeal? 

Miss  KiLBRETH.  Because  there  is  no  appeal  in  this  bill  from,  the  Secretary  of  Labor, 
head  of  the  department  of  which  the  Children's  Bureau  is  a  part. 

Mr.  Barkley.  From  the  Secretary  of  Labor  to  whom? 

Miss  KiLBRETH.  If  a  State  can  not  get  its  quota,  if  the  Children's  Bureau  is  not 
satisfied  about  the  State's  plan  and  refuses  to  give  them  the  funds,  then  the  State 
can  only  appeal  from  the  head  of  the  Children's  Bureau  to  her  chief,  who  is  the  head 
of  the  Department  of  Labor,  the  Secretary  of  Labor.  There  is  no  appeal  beyond 
the  Secretary  of  Labor  at  all.  If  the  Secretary  of  Labor  does  not  approve,  then  he 
covers  the  money  back  into  the  United  States  Treasury.  There  is  no  appeal  to  the 
courts  at  all. 

Mr.  Barkley.  Would  you  have  an  appeal  to  the  President  in  matters  of  that  sort? 

Miss  KiLBRETH.  No;  but  I  think  there  should  be  sisme  other  appeal  than  from  the 
bureau  to  its  chief.  I  think  it  places  enormous  power  in  the  hands  of  the  Children's 
Bureau. 

Mr.  Barkley.  The  courts  are  always  open  where  any  officer  abuses  the  power  that 
Congress  confers  upon  him. 

Miss  KiLBRETH.  No;  not  here,  you  see. 

Mr.  Barkley.  Not  necessarily  in  the  bill,  but  fundamentally. 

Miss  KiLBRETH.  That  was  a  point  made  on  the  floor  of  the  Senate,  and  much  debate 
was  had  upon  it.     The  bill  provides: 

"And  if  the  Secretary  of  Labor  shall  not  direct  such  sum  to  be  paid  it  shall  be 
covered  into  the  Treasury  of  the  United  States." 

There  is  apparently  no  appeal  at  all  from  that,  as  far  as  I  can*  see. 

Mr.  HuDDLESTON.  I  uotico  you  say  that  the  Children's  Bureau  has  indorsed  Madame 
Kollontai 's  system. 

Miss  KiLBRETH.    YcS. 

Mr.  HuDOLESTON.  In  what  way  has  that  indorsement  been  given?  Where  does  it 
appear? 

Miss  KiLBRETH.  It  appears  in  the  book  called  "Maternity  Benefit  Systems  in  Cer- 
tain Foreign  Countries." 

Mr.  HuDDLESTON.  Will  you  read  the  part  of  the  book  that  iudorses  it? 

Miss  KiLBRETH.  It  is  in  the  letter  of  transmittal.  It  says — and  of  course  that  is  a 
matter  of  inference — it  says  that  these  articles  are  published  "in  the  hope  that  the  in- 
formation might  prove  useful  to  the  people  of  one  of  the  few  great  countries  which  have 
as  yet  no  system  of  State  or  national  assistance  in  maternity  in  the  United  States. 

Mr.  HuDDLESTON.  How  is  that  an  indorsement  of  the  Kollontai  plan? 

Miss  KiLBRETH.  Now  we  come  to  where  it  quotes  Mme.  Kollontai,  and  it  says 

Mr.  HuDDLESTON  (interposing).  I  want  to  get  you  to  quote  the  particular  language 
'that  indorses  that  system. 

Miss  KiLBRETH.  It  says  here,  referring  to  this  book  and  gi\ing  its  Russian  name: 
I     ' '  The  most  comprehensive  study  on  maternity  benefits  and  insurance  which  has  yet 
appeared  in  any  language  is  the  volume  by  Mme.  A.  Kollontai." 

Mr.  HuDDLESTON.  That  is  the  basis  of  your  statement  that  the  Children's  Bureau 
has  indorsed  the  Kollontai  svstem? 


I 


186  PUBLIC  PROTECTION"   OF   MATERNITY  AND  INFANCY. 

Miss  KiLBETH.  Yes.  I  don't  know  how  much  they  knew  about  the  later  develop- 
ments.    She  is  still  an  author.     Books  have  just  recently  come  out  about  this  system. 

Mr.  Barkley.  That  book  might  have  been  the  most  comprehensive  study,  and  the 
€hildren's  Bureau  might  not  have  agreed  with  anything  in  it,  might  it  not? 

Miss  KiLBRETH.  Well,  I  take  that  as  an  indorsement.  I  have  been  assured  by 
lawyers  that  it  was  an  indorsement,  and  Senator  Reed  used  it  on  the  floor  of  the  Senate 
yesterday.  There  was  a  debate  between  him  and  Senator  Kenyon,  who  is  sponsoring 
the  bill,  on  that  very  passage. 

Mr.  HuDDLESTON.  You  mean  an  indorsement  of  6  Very  thing  in  the  Kollontai  system? 

Miss  KiLBRETH.  I  should  think  SO)  everything  that  they  knew  about  it.  Now  if  the 
State  is  going  to  take 

The  Chairman  (interposing).  Under  the  arrangement  which  we  have  at  present, 
-which  was  made  before  the  committee  meeting,  you  have  five  minutes  more,  but  I 
think  we  can  stretch  it  to  10.     Beyond  that  we  have  other  witnesses. 

Miss  KiLBRETH.  Now,  Several  Senators  said  on  the  floor  of  the  Senate — it  was  very 
thoroughly  debated  in  December — that  this  system  in  Washington  would  standardize 
all  the  work,  and  they  were  assured  three  times — three  times  by  Senator  Sheppard 
that  it  would  absolutely  not  standardize;  yet  here  is  a  Children's  Bureau  publication, 
entitled  "Standards  of  Child  Welfare,"  probably  the  largest  of  all  their  books.  Here 
are  standards  of  child-welfare  laws,  and  here  is  "Need  of  standardizaq.ion,"  etc.  They 
standardize  everything,  and  at  the  back  there  is  a  list  of  standardizations. 

Mr.  HuDDLESTON.  I  uotice  you  make  frequent  reference  to  "they."  Whom  do  you 
mean  by  "they?" 

Miss  KiLBRETH.  I  mean  the  Children's  Bureau.  When  I  use  it  in  that  connection 
I  mean  the  Children's  Bureau. 

Mr.  HuDDLESTON.  Is  there  any  attempt  on  the  part  of  the  Children's  Bureau  in 
that  publication  you  speak  of  there  to  standardize  anything? 

Miss  KiLBRETH.  Yes;  absolutely. 

Mr.  HuDDLESTON.  Dou't  they  submit  statements  made  by  others  merely? 

Miss  KiLBRETH.  No,  sir. 

Mr.  HuDDLESTON.  Will  you  be  kind  enough  to  read  the  particular  part  of  it  in 
which  they  undertake  to  "standardize"? 
'  Miss  KiLBRETH.  The  statements  are  all  in  the  beginning  of  the  book.  _ 

Mr.  HuDDLESTON.  Is  there  anything  there  that  undertakes  to  standardize  anything? 

Miss  KiLBRETH.  Yes,  sir;  all  that  beginning  is  the  articles  by  delegates. _  The 
standardization  is  at  the  end:  "Minimum  standards  for  the  public  protection  of 
health  of  children."  The  standards  are  "minimum"  and  not  so  extreme  as  some  of 
the  suggestions  of  the  delegates. 

Mr.  HuDDLESTON.  We  are  dealing  with  this  book  now,  however. 

Miss  KiLBRETH.  I  am  saying  that  the  summing  up  is  not  as  extreme  as  the  indi- 
vidual wishes  of  some  of  the  members. 

Mr.  HuDDLESTON.  Will  you  give  me  the  germane  part  that  shows  that  the  Children's 
Bureau  has  attempted  to  standardize  anything? 

Miss  KiLBRETH.  This  is  the  heading:  "Minimum  standards  for  the  public  protec- 
tion of  health  of  children  and  mothers.  Maternity."  Then  follow  these  things 
[indicating]. 

Mr.  HuDDLESTON.  I  do  not  get  anything  out  of  that. 

Miss  KiLBRETH.  Would  you  like  to  look  at  the  book?     This  is  the  summing  up. 

Mr.  HuDDLESTON.  Unlcss  you  can  explain  it  further  so  I  can  get  some  deduction 
from  it. 

Miss  KiLBRETH.  "Adoptiou  of  standards  for  working  basis."  This  is  an  article 
by 

Mr.  HuDDLESTON  (iuterposing) .  You  are  discussing  another  pamphlet  now.  You 
are  dealing  with  something  else. 

Miss  KiLBRETH.  No;  it  simply  clarifies  this  a  little  more. 

Mr.  HuDDLESTON.  I  was  asking  questions  directed  to  the  previous  pamphlet. 

Miss  KiLBRETH.  This  is  their  summing  up. 

Mr.  HuDDLESTON.  Is  there  some  statement  in  there  in  which  the  Children's  Bureau 
or  somebody  authorized  to  speak  for  it  recommended  a  certain  thing  being  done? 

Miss  KiLBRETH.  Thev  do.     This  is  the  summing  up  [indicating]. 

Mr.  HuDDLESTON.  That  is  what  I  was  asking  you  to  read. 

Miss  KiLBRETH.  It  is  quite  loug. 

The  Chairman.  It  might  be  made  a  matter  of  record  to  save  time,  without  reading  it. 

Miss  KiLBRETH.  Here  is  the  book,  if  you  would  like  to  see  it. 

The  Chairman.  Leave  it  with  the  committee  and  make  a  reference  to  it. 

Mr.  HuDDLESTON.  If  they  have  recommended  such  a  thing,  I  would  like  to  hear  it. 

Miss  KiLBRETH.  There  is"  a  page  and  a  half  on  maternity;  then  another  page  and  a 
half  on  infancy. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  187 

Mr.  HuDDLESTON.  I  would  like  to  hear  where  they  recommend  a  certain  thing — 
anything. 

ii'Iiss  KiLBRETii.  It  says  here: 

"The  following  committees  were  appointed  by  the  Washington  conference  to  formu- 
late minimum  standards  of  welfare." 

And  thf^se  are  the  results  [indicating];  these  are  what  they  formulated.  It  is  abso- 
lutely explicit  and  catagorical. 

Mr.  HuuDLESTON.  You  mean  that  then?  That  is  the  basis  of  your  statement  that 
the  Children's  Bureau  has  recommended  the  standardization  that  you  speak  of? 

Miss  KiLURicTH.  This  standardization  here  [indicating].  I  say  that  the  claim  was 
made  over  and  o\er  again  by  Senator  Sheppard  on  the  floor  of  the  Senate  that  they 
would  not  standardize  anything,  and  here  are  the  standardizations. 

Mr.  HuDDLESTON.  Now,  I  am  not  trying  to  deal  with  what  was  said  on  the  floor  of 
the  Senate;  I  want  to  know  what  the  Children's  Bureau  recommend. 

Miss  KiLBRETH.  Theso  are  the  standardizations.  Senator  Sheppard  had  charge  of 
the  bill  in  the  Senate,  and  he  said  it  would  not  standardize  anything. 

Mr.  Denison.  I  would  like  to  have  that  matter  placed  in  the  record — those 
standards. 

The  Chairman.  What  do  you  mean  by  the  standards? 

Mr.  Denison.  The  things  she  is  referring  to. 

The  Chairman.  That  is  the  whole  book,  according  to  her  statement. 

Mr.  Denison.  No;  I  beg  the  chairman's  pardon;  she  stated  about  a  page  and  a 
half  of  it.     It  was  too  long  to  read. 

The  Chairman.  A  page  and  a  half  on  maternity  alone. 

Miss  KiLBRETH.  Then  here  is  another.  Here  is  one  that  has  been  handed  to  me 
[indicating].  Tliis  is  Dr.  McKay,  who  was  one  of  the  speakers — Florence  McKay, 
assistant  director  of  the  Children's  Bureau: 

"These  standards  have  been  published,  and  I  would  like  to  file  with  the  Senators 
here  copies  of  them,  so  they  can  see  what  the  work  for  maternity  and  infancy  will  be." 

Now,  whether  it  was  tliis  book  that  was  filed  or  not  I  do  not  know  [indicating],  but 
there  are  standards  mentioned  over  and  over  again,  yet  it  was  insisted  on  the  floor  of 
the  Senate  that  there  was  no  effort  to  standardize. 

Mr.  Huddleston.  I  understand  that  that  first  bulletin  that  you  took  up  there  was 
issued  by  the  Children's  Bureau? 

Miss  KiLBRETH.    YcS. 

Mr.  Huddleston.  And  showed  the  result  of  a  conference  that  was  held,  and  the 
Tecommendation  made  by  certain  persons. 

Miss  KiLBRETH.  As  a  result  of  the  speeches  and  papers  that  were  read. 

Mr.  Huddleston.  And  that  is  all  it  is? 

Miss  KiLBRETH.  Y^es;  that  is  what  this  is.  They  formulate  then  their  standards 
from  those  speeches. 

Mr.  Huddleston.  Whom  do  you  mean  by  "they"? 

Miss  KiLBRETH.  The  Children's  Bureau  and  the  conference. 

Mr.  Huddleston.  The  persons  who  took  part  in  the  conference  appointed  a  com- 
imittee  that  fjormulated  certain  findings? 

Miss  KiLBRETH.  I  suppose  they  had  a  committee  for  just  that  work. 

Mr.  Huddleston.  But  the  Children's  Bureau  did  not  accept  those  findings,  or 
mate  them  a  part  of  their  recommendations? 

Miss  KiLBRETH.  Oh,  yes;  they  did. 

Mr.  Huddleston.  That  is  what  I  wanted  you  to  read. 

Miss  KiLBRETH.  xVll  right,  I  will  read  it  to  you.  This  is  the  statement.  The  last 
section,  section  6,  is  called  "Standards."     Here  it  is. 

Mr.  Huddleston.  The  last  section  of  what? 

iVIiss  KiLBRETH.  The  last  section  of  the  book  is  called  "Standards." 

Mr.  Huddleston.  Is  that  part  of  the  committee's  findings? 

Miss  KiLBRETH.  The  rest  of  the  book  is  the  speeches  by  these  different  delegates — 
.-flpeeches  and  papers. 

Mr.  Huddleston.  The  standards  are  the  work  of  the  committee.  That  was  for- 
mulated by  the  conference,  wasn't  it? 

Miss  KiLBRETH.  I  suppose  so. 

Mr.  Huddleston.  The  thing  I  wanted  to  get  you  to  read  is  the  specific  indorse- 
ment by  the  Children's  Bureau  of  those  standards. 

Miss  KiLBRETH.  All  right,  this  is  the  work  of  the  committee. 

Mr.  Hl^ddleston.  Before  you  take  up  the  other  pamphlet  that  the  gentleman  has 
handed  you,  I  would  like  to  know  where  it  is  in  that  bulletin  that  you  have  been 
discussing,  the  specific  recommendation  or  indorsement  of  the  findings  of  that  com- 
jnittee. 


L 


188  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Miss  KiLBRETH.  Yes;  it  says  in  the  section  "called  standards,"  section  6 — it 
begins  by  naming  the  committees.     It  says: 

"The  following  committees  were  appointed  by  the  Washington  conference  to 
formulate  minimum  standards  of  child  welfare." 

Of  course  they  had  to  appoint  committees  to  do  that. 

Mr.  HuDDLESTON.  Is  that  statement  the  basis  of  your  assertion  that  the  standards 
formulated  were  adopted  or  recommended  or  indorsed  by  the  Children's  Bureau? 

Miss  KiLBRETH.  Ycs;  and  here  is  a  book  that  has  nothing  in  it  but  standards. 

Mr.  HuDDLESTON.  Well,  that  is  something  else. 

Miss  KiLBRETH.  But  this  is  the  Children's  Bureau. 

Mr.  HuDDLESTON.  I  don't  care  what  that  is;  we  are  talking  about  this  other  book 
now. 

The  Chairman.  Mr.  Huddleston  wants  you  to  confine  your  answers  to  that  one  book 
and  nothing  else. 

Mr.  Huddleston.  You  have  asserted  that  that  bulletin  is  an  indorsement  by  the 
Children's  Bureau  of  certain  standards;  I  want  to  know  what  statements  in  there  you 
base  your  assertion  on. 

Miss  KiLBRETH.  The  last  section  is  called  "standards. ' '  Then  it  says— at  the  begin- 
ning of  this  section  on  standards  it  says — — 

Mr.  Huddleston  (interposing).  I  wanted  to  find  the  particular  part  which  you 
say  indorses,  recommends,  or  adopts  those  standards.     You  say  you  will  give  me  that. 

Miss  KiLBRETH.  I  say  the  committee  has  formulated.  Here  it  is,  "Minimum 
standards  for  children  entering  employment,"  etc.  These  are  all  their  standards, 
which  the  committee  put  out,  and  they  are  published  by  the  Children's  Bureau. 

Then  comes  "Administration,"  "Employment  series"- — all  sorts  of  compulsory 
school  attendance  laws,  etc. — -"Maternity  standards,"  "Infant  care  and  free  schools 
for  children,"  "Adolescent  children." 

Mr.  Huddleston.  Those  are  matters  upon  which  I  have  made  no  question.  I  am 
not  asking  about  them. 

Miss  KiLBRETH.  I  Only  mean  these  are  all  standards 

Mr.  Huddleston  (interposing).  I  am  not  inquiring  about  what  the  standards  were. 

The  Chairman.  Miss  Kilbreth  and  Mr.  Huddleston,  will  you  allow  me  to  break  in 
there?  If  the  Chair  is  correct,  a  member  of  the  committee  desires  you  to  read  to  him 
any  statement  to  the  effect  that,  published  in  that  book  or  any  other  book,  the  Chil- 
dren's Bureau  subscribes  and  adopts  those  standards.     Now  can  you  do  that? 

Miss  Kilbreth.  Yes. 

The  Chairman.  Very  well;  that  is  what  we  want  you  to  do.  It  is  perfectly  simple 
if  you  can  do  it. 

Mr.  Huddleston.  Mr.  Chairman,  I  think  the  witness  understands  my  question. 

Miss  Kilbreth.  I  will  read  this 

The  Chairman  (interposing).  No;  that  wUl  not  answer  the  question,  Miss  Kilbreth 

Miss  Kilbreth.  This  is  the  same  thing  [indicating]. 

The  Chairman.  Well,  never  mind.  You  introduced  that  book;  now  the  gentleman 
wishes  to  examine  you  on  a  statement  about  that  book. 

Miss  Kilbreth.  I  am  perfectly  willing.     Here  it  is. 

The  Chairman.  Now  can  you  or  can  you  not  refer  to  a  definite  indorsement  of  those 
standards,  as  they  may  appear  in  that  book  itself?    You  either  can  or  you  can  not. 

Miss  Kilbreth.  Here  is  the  list.     Here  is  the  work  [indicating]. 

The  Chairman.  That  is  not  what  he  is  asking  you  about. 

Miss  Kilbreth.  Well,  here  are  the  standards  [indicating]. 

The  Chairman.  No;  you  don't  get  the  idea. 

Mr.  Huddleston.  It  has  already  been  answered  to  my  satisfaction,  Mr.  Chairman. 

Miss  Kilbreth.  Here  is  a  separate  pamphlet  with  all  the  standards  in  it  [indicating]. 

Mr.  Rayburn.  Who  appointed  these  committees? 

Miss  Kilbreth.  They  were  appointed  by  the  convention,  which  was  a  convention 
for  the  discussion  of  all  these  child  welfare  matters,  and  these  were  the  committees 
that  were  appointed.  This  is  the  report  on  standards  of  child  welfare,  the  report  of 
the  Children's  Bureau  on  conferences  of  May  and  June,  1919,  to  which  were  invited 
these  distinguished  foreigners. 

Mr.  Rayburn.  And  this  committee  reported,  recommending  certain  standards? 

Miss  Kilbreth.  Very  definite  standards. 

Mr.  Rayburn.  And  the  Children's  Bureau  published  that  book  as  a  document  of 
that  bureau? 

Miss  Kilbreth.  Yes,  it  published  the  book. 

Mr.  Rayburn.  Therefore  you  would  interpret  that  they  would  not  have  published 
that  book  if  they  had  not  indorsed  it? 

Miss  Kilbreth.  Absolutely.  And  here  is  a  separate  book,  containing  simply  the 
rules  and  indorsements  and  standards — nothing  else  [indicating]. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  189 

This  is  a  report  of  the  whole  conference,  and  this  is  simply  the  standards,  summing 
up  of  the  committees  [indicating;!. 

Mr.  Hawes.  Are  those  Government  publications? 

Miss  KiLiJRETH.  Yes;  these  are  all  the  Children's  Bureau  publicationB. 

The  Chairman.  Now,  Miss  Kilhretli,  if  you  liave  a  short  statement  to  make  to  ter- 
minate your  testimony,  1  think  >()U  are  erilitlcd  to  the  opportunity.  You  were  rather 
driA'en  out  of  some  of  your  time.     Will  you  make  it  very  brief,  please? 

Miss  KiLBRETH.  I  do  uot  wisli  to  say  anything  more,  except  that  the  menace  tliat  I 
believe  exists  in  this  bill,  the  Socialist  menace,  is  admitted  in  the  State  Department 
document,  which  was  transmitted  by  Secretary  C'olby  to  Senator  Lodge.  The  sit- 
uation has  not  changed. 

I  will  leave  all  these  books  if  you  care  to  look  at  them. 

And  the  President  in  his  speech  of  acceptance  said : 

'  'It  would  be  the  blindest  of  folly" — tliis  is  President  Harding's  speech  of  accept- 
ance— "it  would  be  the  blindest  of  folly  to  ignore  the  activities  in  our  own  country, 
which  are  aimed  to  destroy  our  economic  system  and  to  commit  us  to  the  colossal 
tragedy  which  has  both  destroyed  all  freedom  and  made  Russia  impotent."  I  will 
leave  this  book  also  with  the  committee,  if  they  care  to  see  it. 

The  Chairman.  Does  any  member  of  the  committee  desire  to  ask  any  further  ques- 
tions of  the  witness? 

Mr.  Hawes.  Is  Miss  Lathrop  to  be  a  witness? 

The  Chairman.  Miss  Lathrop  has  been  asked  by  the  chairman  to  appear  to-morrow 
in  the  time  devoted  to  rebuttal. 

Mr.  Hawes.  I  wanted  to  know  whether  Miss  Latlirop  would  api^ear.  If  she  is  to 
testify,  I  can  ask  her  some  questions  instead  of  asldng  this  witness. 

The  Chairman.  We  will  now  hear  Dr.  Cumming,  of  the  Public  Health  Service. 

STATEMENT  OF  DR.  H.  S.  GUMMING,  SURGEON  GENERAL,   PUBLIC 

HEALTH  SERVICE. 

The  Chairman.  Members  of  the  committee,  I  wish  to  state  to  you  that  Dr.  Cum- 
ming and  several  others  of  his  department  have  been  asked  to  come  here  in  order  that 
we  might  find  out  what  part  the  Public-Health  Service  has  been  playing  in  respect 
of  health  matters,  affecting  the  purposes  of  this  bill  which  is  now  before  us.  You 
may  make  your  statement. 

Dr.  Cumming.  I  thank  you,  Mr.  Chairman,  and  gentlemen  of  the  committee,  I 
have  not  had  the  opportunity  to  attend  the  hearings  of  this  committee  on  this  bill, 
Mr.  Chairman,  and  I  must  confess  that  in  my  mind  there  is  still  some  doubt  as  to 
the  intent  of  the  bill.  I  know  that  people  with  whom  I  have  talked  as  members  of 
various  societies  throughout  the  country  indorsed  the  bill  and  had  rather  in  mind  a 
mental  picture  of  a  trained  doctor  and  nurse  who  attended  women  before,  during, 
and  after  child-birth.  I  have  been  told  that  stress  has  been  laid  during  the  hearings 
upon  the  fact  that  the  medical  and  surgical  side  of  the  bill  is  rather  a  small  part  and 
that  the  bill  pertains  more  to  sociological  and  economics  studies.  Our  viewpoint 
of  the  bill  will  depend  a  great  deal  upon  what  the  bill  is  intended  to  do.  I  think 
there  is  no  question  as  to  the  desirability  of  measures  for  protection  of  maternal  and 
infant  life.  There  is  some  question,  however,  as  to  the  desirability  of  methods  pro- 
posed to  accomplish  the  purposes  of  this  bill,  if  I  imderstand  it  rightly.  It  is  not 
believed  that  any  group  of  the  population  should  be  given  a  separate  consideration 
in  this  way.  As  efficiency  in  the  work  which  the  successftil  conservation  of  maternal 
and  child  life  involves  the  entire  field  of  public  health,  for  instance,  venereal  disease, 
pellagra,  which  is  now  breaking  out  again  in  the  South,  and  so  on.  Some  of  the  most 
frequent  problems  of  maternal  and  child  mortality  are  obviously  problems  which 
can  be  successfully  handled  only  by  the  application  of  general  health  measures. 
For  instance,  some  of  these  are  with  regard  to  avoidance  of  puerperal  infection  which 
is  one  of  the  most  important  causes  of  maternal  mortality. 

In  view  of  the  fact  that  such  a  large  part  of  this  problem  is  medical  and  sanitaiy, 
to  our  mind,  rather  than  social  and  economic,  it  is  our  thought  that  some  provision 
should  be  made  in  the  bill  for  the  utilization  to  the  fullest  extent  of  the  medical  and 
sanitary  pers  )nnel  of  the  Public  Health  Service  in  order  to  carry  out  the  evident 
desire  of  the  administration,  and  I  think  both  parties  for  the  coordination  of  effort 
with  regard  to  the  public  health  work.  I  think  it  is  important  for  this  reason,  in 
considering  legislation,  to  avoid  duplication  of  existing  public  health  machinery 
and  to  utilize  to  the  greatest  advantage  all  of  the  health  agencies  already  at  hand. 
.  From  a  study  lasting  over  some  years  made  by  the  Public-Health  Ser\ice  of  the  organi- 
f  zations  already  created  and  developed,  national.  State,  and  local  health  agencies, 
I  am  of  the  opinion  that  more  specific  provision  should  be  made  in  the  bill  for  this 


i 


190  PUBLIC   PROTECTIOlSr  OF  MATEENITY  AITD  INFANCY. 

utilization  of  Federal  and  local  health  agencies  now  in  existence.  For  the  purpose^ 
therefore,  of  carrying  out  the  medical  and  sanitary  work  contemplated  under  this 
bill  there  can  not  be  any  difference  of  opinion  as  to  the  desirability  of  making  full 
use  of  the  Public-Health  Service.  I  think  that  you  probably  have  had  a  great  many 
hearings  on  the  theoretical  side  of  this  bill  and  that  it  would  be  more  profitable  to 
the  committee  if  we  had  instead  of  a  general  discussion  of  the  bill,  several  of  our 
officers  who  have  been  engaged  in  this  work  for  a  great  many  years. appear  before  you 
in  order  that  you  might  question  them  as  to  the  practical  application  of  the  bill. 
That  is  really  all  I  have  to  say,  Mr.  Chairman,  excepting  to  answer  such  questions  as 
the  committee  may  want  to  place  before  me.  I  will  state  that  this  meets  with  the 
approval  of  the  secretary,  that  is,  my  statement. 

The  Chairman.  Does  any  member  wish  to  ask  Dr.  Cumming  a  question? 

Mr.  Denison.  Some  of  the  witnesses  have  stated  here  that  the  Public-Health 
Service  had  not  taken  any  interest  in  this  subject  of  maternity  and  child  birth  treat- 
ment, and  that  there  would  not  have  been  anything  substantial  done  along  this  line 
in  the  way  of  investigation,  and  in  the  way  of  furnishing  information  if  the  Children's 
Bureau  had  not  taken  it  up.  I  have  heard  that  statement  made  and  want  to  know  if 
that  is  true  or  not,  as  far  as  you  know. 

Dr.  Cumming.  I  am  under  the  impression  that  a  great  many  such  wild  statements 
have  been  made.  As  a  matter  c»f  fact,  the  day  that  I  reported  to  the  Hygiene  labora- 
tory of  the  bureau  in  1912  for  work  during  the  latter  part  of  Mr.  Taft's  administration, 
a  short  time  after  the  bill  had  been  passed  allowing  us  to  do  this  work,  I  think  the 
first  room  I  went  into  in  order  to  enter  the  laboratory  was  presided  over  by  one  of  the 
doctors  here  now  who  was  detailed  in  the  investigation  and  study  of  the  value  of 
pasteurization  of  milk,  infant  feeding.  The  amount  of  work  that  has  been  done  by 
the  service  so  far  as  I  know  has  been  limited  only  by  the  appropriations  available. 
Within  the  past  12  months  or  so,  perhaps  18  months,  the  Public-Health  Service  has 
had  a  request  from  State  authorities  to  assist  in  the  organization  and  development  of 
seven  divisions  of  child  hygiene.  We  have  attempted  in  this  instance,  as  we  do  in 
rural  sanitation  and  in  all  phases  of  industrial  hygiene,  to  assist  the  State  or  industry 
of  the  county  to  develop  its  own  organization,  to  make  it  self-supporting,  and  then  to 
leave  it. 

I  happened  to  have  on  my  desk  the  former  estimates  submitted  to  the  Surgeon 
General  by  the  chief  of  the  division  under  which  this  work  comes,  and  I  am  very 
much  interested,  in  view  of  the  statement  which  you  made,  to  see  that  he  asks  for 
investigation  of  child  hygiene  $200,000,  and  he  goes  on  to  the  item  of  general  study  of 
mental  hygiene  of  children,  $15,000.  The^e  studies  are  needed  to  determine  the 
causes  that  bring  about  the  maladjustment  Of  the  child  to  its  environment  and  of  other 
mental  defects  and  to  find  methods  for  their  prevention.  I  might  state  that  the  piece 
of  work  with  the  State  of  Oregon  along  that  line  is  considered  very  Valuable.  Also 
studies  of  physical  education  to  determine  the  best  educational,  recreational  and 
constructive  measures  in  the  schools,  to  promote  regular,  rapid  and  healthful  physical 
development  of  children;  research  in  the  pathology  of  antenatal  or  early  infant  mor- 
tality, $15,000.  This  chief  made  a  statement  at  that  time  that  nearly  one-half  of  the 
infants  in  the  first  year  of  life  died  during  the  first  year  after  their  birth.  Therefore, 
a  study  should  be  made  of  the  conditions  of  the  antenatal  period  and  the  period 
immediately  after  birth. 

Those  studies  constitute  a  most  important  part  of  the  work  devoted  to  the  conserva- 
tion of  child  health.  The  object  would  be  to  perfect  child  health  organizations  in 
State  departments  of  health  and  where  practical  to  leave  behind  as  a  result  of  a  division 
of  child  h3''giene  in  the  State  to  carry  on  the  work,  and  so  forth. 

I  think  the  statement  could  hardly  be  borne  out  in  view  of  the  studies  of  oral  hy- 
giene, made  by  the  service. 

I  might  state  that  the  work  of  this  character,  including  the  organization  of  these 
divisions,  was  done  at  an  expense  of  about  somethiBg  less  than  $70,000,  including 
salaries  during  the  last  fiscal  year.  I  might  state  that  recently  at  the  request  of  the 
State  of  Utah  we  has^e  started  work  of  similar  character  combined,  as  we  believe  it 
should  be  combined,  in  a  campaign  through  the  State  for  general  health  work  in  which 
tuberculosis  is  also  included  as  well  as  child  hygiene  work  and  general  rural  sanita- 
tion, which,  as  a  matter  of  efficiency,  should  be  done  together. 

The  State  of  Florida  has  requested  us  to  do  the  same  soit  of  work,  and  I  am  not 
quite  sure  whether  the  officer  has  already  gone  down  there  or  not,  but  he  has  been 
ordered.  The  question  with  us  has  not  been  a  lack  of  desire;  it  has  been  a  lack  of 
two  things.  One  is  money  and  the  other,  equally  impoitant,  the  lack  of  trained 
personnel. 

The  Chairman.  Anything  further? 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  191 

Mr.  Mapks.  I  wanted  to  ask  in  what  way  those  roquests  came  to  you;  through  what 
agency  of  the  State? 

Dr.  CuMMiNc.  Very  frequently,  when  any  other  agency  in  the  .State  asks  us  to  do 
the  work,  we  refer  it  l)ack  to  the  official  State  channels,  the  State  board  of  health. 
The  ofRcial  re((uest  has  come  to  us  in  that  way  so  that  we  may  cooperate  with  that 
State,  in  accordanc '  with  law,  through  the  regular  channels  of  the  State  authorities. 
Mr.  Mapks.  Do  I  understand  you  to  say  that  the  State  of  Utah  and  the  State  of 
Florida  made  official  requests? 

Dr.  CuMMiNO.  They  always  do,  as  far  as  I  know,  unless  there  is  an  epidemic,  and 
then,  of  course,  the  Federal  Government  has  authority  to  go  in  whenever  it  thinks 
the  State  fails.     That,  in  modem  times,  has  been  very  rare. 

Mr.  Baukley.  Whatever  bureau  might  have  charge  of  the  administration  of  this 
law,  it  would  have  to  be  done  through  cooperation  with  the  State  boards,  would  it  not? 
Dr.  CuMMiNC.  It  should  be  so  done,  I  think,  Mr.  Chairman. 

Mr.  Barkley.  So  that  you  would  not  have  direct  charge  of  the  actual  contact  with 
the  people  involved  in  this  law  from  Washington? 

Dr.  CuMMiNr,.  I  do  not  conceive  that  to  be  the  proper  way  for  the  Federal  Govern- 
ment to  go  into  this  business. 

Mr.  Mapes.  The  object  of  the  entire  matter  and  the  administration  of  it  is  to  stimu- 
late the  State  to  do  this  thing  themselves? 

Dr.  CuMMiNo.  We  feel,  Mr.  Chairman,  that  we  have  made  a  mistake  in  general 
health  work  if  at  the  end  of  a  reasonable  length  of  time  we  can  not  leave  the  State  to 
run  its  own  affairs  in  reference  to  that. 

Mr.  Barkley.  Is  it  not  true  that  in  practically  all  of  the  States,  to  some  extent,  that 
the  State  board  operate  through  local  boards,  county  and  city  health  officials? 
Dr.  CuMMiNG.  Yes,  sir. 

Mr.  Barkley.  That  is,  in  carrying  on  the  work  with  the  State  board  of  health? 
Dr.  Gumming.  The  success  of  the  health  work  to-day  depends  on  the  efficiency  of 
the  county  board  of  health. 

Mr.  Barkley.  That  leads  me  to  ask  this  question.  Do  you  believe  that  the  aver- 
age county  physician  or  county  health  officer  who  has  been  elected,  maybe  for  political 
reasons,  is  the  sort  of  man  who  ought  to  ba  in  charge  locally  of  work  such  as  is  contem- 
plated in  this  bill? 

Dr.  Gumming.  We  are  trying  to  stimulate  the  different  counties,  Mr.  Chairman,  to 
get  whole-time  health  officers  who  are  competent. 
Mr.  Barkley.  Have  they  been  successful  in  that? 

Dr.  Gumming.  No;  and  I  do  not  see  how  the  passage  of  any  bill  would  create  in  the 
county  a  competent  health  doctor. 

_  Mr.  Barkley.  No;  but  the  thought  I  had  was  this.  There  has  been  wide  opposi- 
tion to  this  bill  on  the  ground  that  it  proposes  to  compel  people  to  accept  govern- 
mental attention  and  treatment.  "^Tiether  that  opposition  has  been  sincere  or  whether 
it  has  been  based  upon  fancy,  I  do  not  know,  but  it  has  been  expressed  that  this  bill 
leads  to  governmental  medicine,  and  leads  to  the  sending  of  physicians  by  the  Gov- 
ernment to  treat  prospective  mothers  and  mothers  who  have  given  birth  to  children. 
It  would  be  unfortunate  if  any  such  impression  became  widespread  because  noth- 
ing like  that  is  contemplated.  Anyone  who  understands  the  plainest  English  knows 
that  is  not  true.  But  there  has  been  an  effort  made  to  create  that  impression  and 
there  has  been  testimony  before  this  committee  last  year  or  this  based  on  that  opposi- 
tion. If  it  should  turn  out  that  the  administration  of  this  law  were  placed  exclusively 
in  the  health  department,  whether  it  be  of  the  Nation  or  of  the  State  and  going  on 
down  to  contact  with  the  people,  and  the  Government's  assistance  was  brought  to 
the  people  and  in  contact  with  them  through  inefficient  local  politically  chosen 
doctors  or  health  officers,  would  that  not  be  rather  an  unfortunate  condition? 

Dr.  Gumming.  I  can  not  conceive  of  such  a  condition  existing  very  well,  Mr. 
Barkley. 

Mr.  Barkley.  How  are  you  going  to  get  around  it  when  we  have  no  power  to 
select  and  ought  not  to  have  the  power  to  select  local  officials  who  are  to  work  in 
harmony  under  the  supervision  of  State  boards  of  health,  and  not  only  in  health 
matters,  quarantine,  vaccination,  and  things  like  that,  but  that  they  shall  have 
instruction  of  and  the  most  intimate  relationship  with  the  mothers,  prospective 
mothers,  about  mattere  in  which  they  are  not  called  as  the  family  physician  but  as 
public  officers? 

Dr.  Gumming.  How  would  I  ob^'iate  that? 
Mr.  Barkley.  Yes. 

Dr.  Gumming.  I  would  think  that  would  be  a  matter  for  the  community  to  stop. 
You  would  be  operating,  as  you  say,  through  the  local  authority.  They  would  have 
been  elected  by  the  locality,  presumably.  It  is  up  to  the  locality  to  turn  them  out 
at  the  next  election. 


192  PUBLIC  PROTECTIOlSr   or   MATERNITY  AND  INFANCY. 

Mr.  Barkley.  Yes,  but  they  do  not  do  it. 

Dr.  Gumming.  I  remember  hearing  a  former  Speaker  of  the  House  of  Representa- 
tives say  that  every  community  got  as  good  elective  officers  as  they  deserved.  It 
was  up  to  them  to  vote  for  them.    I  always  thought  that  was  a  pretty  good  statement. 

Mr.  Barkley.  It  is  frequently  stated  that  a  successful  physician  would  not  have 
one  of  these  local  jobs  and  frequently  a  man  is  appointed  who  has  either  gotten  some- 
what superannuated  or  has  not  been  thoroughly  successful  in  his  practice.  That  is 
not  the  universal  rule.  There  are  many  very  high-class  county  health  officers,  but  it 
is  not  at  all  uncommon  to  see  the  other  sort. 

Dr.  Gumming.  I  think  that  is  a  reflection  upon  the  medical  profession  which  it 
does  not  deserve.  I  know  of  numbers  of  free  clinics,  eye  clinics,  children's  clinics, 
and  dental  clinics,  to  which  men  who  have  enormous  incomes  give  up  hours  of  their 
time  every  day  to  carry  on  the  work  fi"e»  for  the  benefit  of  mankind. 

Mr.  Barkley.  That  is  to  their  credit,  but  that  does  not  mean  that  that  is  the 
universal  rule. 

Mr.  Rayburn.  Is  it  not  true  that  the  overwhelming  majority  of  the  doctors  who  are 
county  health  officers  are  efficient? 

Dr.  Gumming.  Are  efficient? 

Mr.  Rayburn.  Yes. 

Dr.  Gumming.  I  think  the  number  of  efficient  health  officers  within  the  last  two 
or  three  years,  and  I  confess  I  do  not  know  as  much  about  it  as  Dr.  Lumsden,  who  comes 
in  daily  contact  with  them,  are  hundreds  of  per  cent  better  than  five  years  ago. 

Dr.  Barkley.  Do  you  distinguish  between  health  officers  and  county  physicians 
whose  duty  primarily  is  to  give  medical  attention  to  paupers  in  the  county? 

Dr.  Gumming.  That  depends  on  the  county  organization.  We  feel  that  the  typical 
organization  in  the  county  which  will  be  described  to  you  better  by  Dr.  Lumsden 
should  have  a  whole-time  health  officer  and  visiting  inspecting  nurses. 

Mr.  Barkley.  I  am  not  speaking  about  the  health  doctor,  but  I  am  speaking  about 
the  man  whose  duty  is  not  to  look  after  quarantine  matters  and  matters  of  health 
which  some  high-class  physician  may  have  charge  of,  but  some  one  whose  chief  duty 
is  simply  to  go  about  over  the  county  and  give  medical  attention  to  paupers  who  are 
not  able  to  employ  a  physician.  Would  those  men  have  anything  to  do  with  the 
administration  of  this  law? 

Dr.  Gumming.  I  have  not  been  consulted  at  all  about  this  law  and  I  have  no  idea 
what  is  intended  to  have  done  here. 

Mr.  Barkley.  You  have  some  idea  how  the  State  departments  ought  to  handle 
legislation  of  this  sort  with  the  duties  under  it. 

Dr.  Gumming.  I  should  think  the  average  State  department  would  be  rather  careful 
in  picking  out  competent  physicians.     That  is  a  matter  of  conjecture. 

Mr.  Barkley.  If  it  should  turn  out  that  the  administration  of  these  duties  as  they 
are  brought  in  close  contact  with  the  average  woman  in  the  county,  were  administered 
by  the  county  doctor  for  the  poor,  would  that  not  create  in  women  who  were  not  so 
situated  and  who  might  need  that  sort  of  attention  and  education  a  sort  of  resentment 
against  the  operation  of  the  law,  that  they  were  placed  on  the  basis  of  the  poor  paupers 
of  the  county,  and  that  the  State  or  Government  was  trying  to  teach  them  something 
about  maternity? 

Dr.  Gumming.  It  would  be  rather  hard  to  tell  about  the  mental  reactions  of  that 
sort  of  thing.  There  are  certain  types  of  peolple  who  resent  very  bitterly  being  carried 
to  a  hospital  at  all.  I  can  not  conceive,  though,  that  the  Government  would  force 
itself  upon  anybody. 

Mr.  Barkley.  No;  that  is  what  I  understand.  There  is  nothing  in  this  law  that 
forces  the  Government  upon  anybody,  but  there  has  been  a  very  wide  propaganda 
by  some  of  those  who  are  against  it  that  it  does  mean  compulsory  Government  medical 
attention. 

Dr.  Gumming.  It  is  conceivable  under  this  law  that  where  such  rules  might  be 
required  by  the  State  authority  that  would  allow  forcible  attention.  I  do  not  know 
what  the  intention  is. 

Mr.  Barkley.  No  matter  who  is  charged  with  the  duty  they  have  got  to  have 
discretion  to  make  uniform  rules  and  regulations  and  cooperate  with  the  State,  and  if 
it  was  left  to  your  bureau,  you  would  expect  to  make  uniform  regulations  in  as  far  as 
they  could  apply  subject  to  be  flexible  with  reference  to  conditions  in  each  State. 

Dr.  Gumming.  Absolutely. 

Mr.  R,ayburn.  Do  you  consider  the  question  of  maternity  and  child  care  to  be 
more  than  50  per  cent  a  medical  question? 

Dr.  Gumming.  It  is  hard  to  tell  any  percentage.  A  great  deal  of  it  is  medical  and 
nursing. 

Mr.  Rayburn.  You  would  deal  with  it  as  a  medical  question? 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  193 

Dr.  Gumming.  Very  largely  a  medical  and  nursing  question. 

Mr.  Rayburn.  It  is  very  hard  to  get  a  doctor's  license  under  the  laws  of  the  different 
:State9  as  rigid  as  they  are  now,  to  iind  a  licensed  doctor  who  practices  who  is  not 
■more  capable  of  administering  this  law  than  a  layman. 

Dr.  duMMiNG.  Despite  the  reflection  upon  the  medical  profession  we  have  heard 
so  mu(;h  of,  I  think  the  average  doctor  is  much  more  capable  of  advising  a  woman 
and  delivering  her  than  the  average  layman  or  lay  woman. 

Mr.  R.WBURN.  I  think  it  would  be  very  easy  to  develop  that  even  in  the  small 
towns  of  four  or  five  or  six  thousand  people,  like  the  one  near  which  I  live.  I  do  not 
livein  town,  and  I  do  not  think  anybody  ought  lo.  It  is  a  town  of  0,000,  and  we  get 
the  best  doctors  in  the  to^Ti  or  in  the  county  lo  be  city  health  officer.  They  get 
very  little  pay,  but  they  do  a  great  service  and  ihey  like  to  do  it  and  feel  proud  and 
honored  to  be  called  upon  by  the  city  council  to  look  after  the  sanitation  of  the  people 
in  the  small  town. 

Dr.  ('uMMiNG.  I  think  most  of  the  great  advances  in  medicine  have  been  made 
by  small  town  and  country  doctors,  if  you  read  the  history  of  medicine. 

Mr.  Bartley.  I  want  to  disabuse  your  mind  of  any  impression  that  I  was  intending 
to  reflect  on  health  officers  of  counties. 

Dr.  Gumming.  I  understand  that. 

Mr.  Bartley.  What  I  meant  was  that  all  over  the  country  they  are  not  health 
officers.  In  my  State  we  have  a  health  officer  and  then  we  have  a  county  physician, 
and  the  county  physician  is  a  political  appointment,  and  that  is  what  I  was  talking 
about  awhile  ago. 

Mr.  Hawes.  Were  you  invited  to  this  conference  on  Standards  of  Ghild  Welfare 
called  by  the  Ghildren's  Bureau? 

Dr.  Gumming.  TMiat  is  the  date  of  that?    I  do  not  recall  that. 

Mr.  Hawes.  May  and  June,  1919. 

Dr.  Gumming.  I  think  I  was  in  Europe  at  that  time.  I  do  not  think  anybody  in 
•otir  bureau  was  invited  as  far  as  I  know.  I  asked  Dr.  Schereschewsky  yesterday 
about  it. 

Mr.  Hawes.  Yoiu*  department  has  prepared  voluminous  reports  on  the  subject  of 
milk  and  various  other  child  foods,  have  you,  not? 

Dr.  Gumming.  Yes,  sir;  I  think  I  have  a  partial  exhibit  here.  I  do  not  see  the 
names  of  any  of  our  people  here. 

Mr.  Hawes.  I  want  to  know  whether  you,  the  representative  of  an  old  established 
•department  supported  by  United  States  money,  who  have  been  carrying  on  a  series 
of  experiments  for  a  number  of  years,  were  asked  your  advice. 

Dr.  Gumming.  No,  sir;  I  think  we  must  have  been  frozen  out  of  it.  There  is  no 
name  there  of  anybody  attached  to  our  service.  I  notice  the  names  of  many  gentle- 
men whom  I  know,  both  from  abroad  and  here,  and  some  of  them  are  doctors,  and 
some  are  not. 

Mr.  Hawes.  You  made  an  observation  to  the  effect  that  the  work  of  your  depart- 
ment could  be  established  in  the  State  and  then  a  study  carried  on  without  your 
further  assistance. 

Dr.  Gumming.  It  is  a  little  different  from  that  in  that  we  go  down  to  assist  a  State. 
With  your  permission,  I  think  Dr.  Lumsden,  who  had  charge  of  so  much  of  that  work, 
will  describe  in  detail  that  work.  We  send  a  man  down,  a  trained  worker,  to  cooper- 
ate through  the  State  with  the  county  people  or  the  town  people,  ordinarily  in  estab- 
lishing local  board  of  health,  assisting  it  in  reorganizing  the  State  board  of  health. 
He  is  working  in  that  instance  with  the  State  health  officer  and  is  subject  to  such 
general  directions  as  the  State  health  officer  may  desire.  In  other  words,  we  never 
force  a  Federal  officer  into  a  State. 

Mr.  Hawes.  But  after  the  work  is  established  in  the  State  your  work  is  practically 
•completed,  is  it  not? 

Dr.  Gumming.  Yes. 

Mr.  Hawes.  You  do  not  find  it  necessary  to  take  charge  of  the  State  agency  or 
direct  it  in  any  way? 

Dr.  Gumming.  I  would  think  that  the  Federal  Government  was  going  beyond  its 

i'urisdiction  if  we  attempted  to  do  that  and  that  we  would  be  a  failure  as  a  Federal 
lealth  service.  In  two  of  the  States  right  now  I  recall  two  of  our  officers  who  are 
acting  as  State  and  deputy  State  health  officers  at  the  request  of  the  governor  and 
the  legislature  of  the  State  in  order  to  organize  for  them  their  State  health  work. 
For  instance,  I  recall  Missouri  and  New  Mexico. 

Mr.  Hawes.  It  is  just  about  the  same  way  the  Federal  roads  department  will  lend 
its  engineers  to  the  State  roads  department  for  a  limited  time  and  then  withdraw 
I  .them? 

74654—21 13 


E_ 


194  PUBLIC  PEOTECTION   OF  MATERNITY  AND  INFANCY. 

Dr.  Gumming.  We  are  doing  that  now,  and  the  sanitary  engineers  are  organizing; 
sanitary  engineering  divisions  in  the  State,  just  as  we  have  been  doing  with  child 
hygiene  divisions. 
Mr.  Hawes.  You  do  not  undertake  to  direct  and  control  all  of  these  departments'!^ 
Dr.  Gumming.  Not  at  all. 

]VIr.  Hawes.  In  other  words,  after  putting  them  on  their  feet  and  supplying  them 
with  the  methods  of  organization  and  develop  a  plan,  you  withdraw? 
Dr.  Gumming.  Yes,  sir. 

Mr.  Hawes.  That  is  the  extent  to  which  the  health  department  of  the  United 
States  goes? 
Dr.  Gumming.  With  the  exception  of  enforcing  laws  in  epidemics  of  disease. 
I  will  state  for  the  information  of  the  committee,  although  I  think  you  already  know 
it,  that  we  are  furnishing  the  medical  side  of  the  work  and  have  for  years  in  the  Inuni- 
gration  Service,  the  Bureau  of  Mines,  and  in  the  Agricultural  Department,  the  Bureau 
of  Ghemistry,  and  we  are  just  organizing  some  health  work  now  for  the  Post  Office- 
Department  and  some  other  departments.    We  cooperate  with  a  great  many  of  them, 
now. 
Mr.  Hawes.  What  was  the  work  of  the  department  during  the  war? 
Dr.  Gumming.  Our  department? 
Mr.  Hawes.  Yes. 

Dr.  Gumming.  It  was  rather  varied.  Some  of  the  officers  were  directly  connected 
with  the  war,  in  that  we  furnished  medical  officers  for  Coast  Guard  vessels.  They,  of 
course,  remained  on  the  Goast  Guard  boats,  and  some  of  them  were  in  France  on  patrol 
work.  Several  of  us — I  happened  to  be  detailed  over  to  the  Division  of  Sanitation 
in  the  Navy  Department  at  first,  and  afterwards  went  over  for  sanitation  of  ports  iit 
France,  etc. 

We  had  an  advisor  in  sanitation  for  each  of  the  13  naval  districts  who  had  charge  of 
that  character  of  work.  Our  medical  officers  were  detailed  to  have  charge  of  the  gen- 
eral sanitation  in  this  country  outside,  of  the  actual  military  zone,  of  the  various- 
divisions,  posts,  camps,  forts,  etc. 

Mr.  Hawes.  Will  you  have  inserted  in  the  record  the  list  of  bulletins  on  the  subject 
of  pubhc  health  that  are  issued  by  your  department? 

(See  Miscellaneous  PubUcation  No.  12— PubUcations  of  the  U.  S.  Pubhc  Health 
Service— April,  1921.) 

Dr.  Gumming.  I  will  be  very  glad  to  do  so.  In  addition  to  that  I  might  state  that 
some  of  the  other  officers  were  directly  connected  with  the  Army,  being  reUeved  for 
the  time,  however,  from  our  service. 

Mr.  Hawes.  What  did  you  have  to  do,  for  instance,  with  a  training  camp  that  was- 
located  near  a  city  in  connection  with  the  hygiene  of  the  men  and  women  and  children 
in  the  neighborhood? 

Dr.  Gumming.  We  had  charge  of  the  general  sanitation  of  the  area  around  the  camp^ 
Mr.  Hawes.  All  the  camps? 

Dr.  Gumming.  All  the  camps  as  far  as  I  recall.    We  worked  with  the  local  health 
departments. 
til.  Hawes.  Therefore  you  went  into  matters  relating  to  women  and  children. 
Dr.  Gumming.  Yes,  sir;  I  understand  you  had  this  morning  some  description  of  the 
work  in  Texas  around  those  camps. 

Mr.  Hawes.  That  work  in  Texas  was  carried  on  pretty  generally  throughout  the 
United  States,  wherever  there  were  camps  or  sunilar  to  that. 

Dr.  Gumming.  More  or  less.  I  was  not  here  at  the  time.  Dr.  Schereschewsky  could 
answer  you  better.  I  was  not  on  duty  with  the  service  at  that  time.  I  was  on  duty 
with  the  Navy. 

Mr.  Hawes.  This  bill  provides  for  |10,000  to  be  appropriated  to  the  State  without, 
regard  to  the  size  of  the  State,  and  the  State's  proportion  of  the  total  for  a  large  State 
would  be  approximately  $40,000.  There  was  some  suggestion  made  of  hospitaliza- 
tion in  the  various  counties  of  the  State.  I  studied  this  over  for  my  State  and  find 
that  if  in  each  county  a  hospital  was  built  with  national  money,  there  would  be  only 
about  $350.     It  would  not  do  much  for  hospitalization  in  the  counties. 

Dr.  Gumming.  If  you  will  allow  me  to  interject  a  remark  there  I  want  to  say  that  I 
know  nothing  whatever  of  what  one  of  the  witnesses  called  the  Moses  amendment^ 
stating  our  attention  was  called  to  it  this  afternoon.  I  do  not  know  who  originated  it. 
I  will  say  that  taking  the  country  as  a  whole  it  would  take  $3,000  to  $3,500  a  bed  to- 
build  a  hospital. 

Mr.  Barkley.  I  might  interject  that  the  Senate  defeated  the  Moses  amendment 
by  a  vote  of  61  to  9  this  afternoon. 
Dr.  Gumming.  I  know  nothing  of  it. 


PUBLIC  PEOTECnON'  OF  MATERNITY  AND  INFANCY.  195 

Mr.  Mapes.  I  do  not  know  whether  you  ake  prepared  to  answer  this  question  or  not, 
but  I  would  like  to  get  a  statement  from  sorne  one  about  it.  I  understood  you  to  say 
that  you  had  not  made  a  detailed  study  of  this  bill.  As  I  understand  it  the  purpose 
of  the  bill  is  to  provide  means  for  the  education  of  the  people,  and  especially  the  women 
of  the  country  in  the  care  of  maternity  and  infancy.  Can  you  tell  us  briefly  just  what 
your  department  is  doing  along  that  line  now? 

Dr.  CuMMiNo.  Will  you  not  let  me  give  you  the  actual  information  from  the  ofTicer 
who  has  immediate  charge  of  it?     I  think  it  would  be  more  satisfactory. 

Mr.  Mapes.  If  I  may  interject  another  thought  that  I  have  in  mind  so  that  the  next 
speaker  may  have  it  in  mind,  I  would  like  if  we  can  to  find  out  just  how  much  dupli- 
cation of  that  part  of  the  work  of  instructing  people  in  the  care  of  maternity  and 
infancy  there  is  in  the  Public  Health  Service  and  the  Children's  Bureau  in  the  Labor 
Department? 

Dr.  CuMMiNo.  Duplication  at  present? 

Mr.  Mapes.  Yes,  sir. 

Dr.  Gumming.  I  know  of  one  in  which  there  is;  possibly  there  have  been  two  pam- 
phlets covering  about  the  same  field.  There  is  that  question  possibly,  but  as  far  as  the 
work  is  concerned  the  country  is  large  and  the  appropriation  for  both  bureaus  has  been 
small.     There  are  3,000  counties  in  this  country. 

The  Chairman.  We  are  very  much  obliged  to  you,  Doctor. 

STATEMENT  OF  DR.  J.  W.  SCHERESCHEWSKY,  ASSISTANT  SURGEON 
GENERAL,  UNITED  STATES  PUBLIC  HEALTH  SERVICE,  IN 
CHARGE  OF  THE  DIVISION  OF  SCIENTIFIC  RESEARCH. 

Dr.  Schereschewsky.  Mr.  Chairman,  shall  I  proceed? 

The  Chairman.  Proceed,  if  you  will,  if  you  have  anything  in  mind  especially. 

Dr.  Schereschewsky.  Of  course  I  have  a  great  deal  that  I  would  like  to  say. 
I  would  like  to  say  in  the  beginning  there  is  an  urgent  necessity  for  the  extension  of 
public  health  work  and  a  very  important  phase  of  public  health  work  is  protection 
of  maternal  and  child  life.  Such  protection,  of  course,  should  of  necessity  be  part 
of  the  general  public  health  program  of  the  country  because  you  can  not  dissociate 
the  protection  of  the  mother  and  the  infant  from  the  general  public  health  problem. 
A  good  many  years  ago  we  took  up  the  question  of  tuberculosis  as  a  specific  phase  of 
public  health  work,  which  ought  to  be  controlled  and  prevented  by  specific  public 
health  measures,  and  now  the  National  Tuberculosis  Association,  public  health 
workers,  workers  in  tuberculosis  especially,  appreciate  that  the  prevention  and  con- 
trol of  tuberculosis  is  a  part  of  the  general  health  program  and  that  in  proportion  as 
you  improve  the  general  health  of  the  population  you  will  diminish  and  control 
tuberculosis. 

When  one  speaks  of  the  protection  of  maternal  and  child  life,  then  the  same  thing 
applies.  A  minimum  maternal  death  rate  and  a  minimum  infant  mortality  rate 
does  not  depend  on  the  application  of  specific  measures  applied  solely  to  the  mother 
and  the  child,  but  depends  upon  the  summation  of  the  efltects  of  a  large  number  of 
favorable  health  conditions,  all  of  which  react  to  the  advantage  of  the  mother  and 
the  prolongation  and  conservation  of  the  health  of  the  children.  If  we  wish  to  di- 
minish to  the  greatest  possible  extent  preventable  deaths  among  mothers  and  babies 
we  must  of  necessity  begin  work  by  establishing  a  basic  public  health  program.  We 
must  inculcate  in  the  local  community  the  sense  of  responsibility  for  its  own  health 
conditions,  and  stimulate  the  community  to  provide  scientific  means  to  protect  the 
life  of  all  the  citizens  from  the  cradle  to  the  grave.  Until  we  adopt  these  several 
measures  we  will  make  very  little  headway  by  specific  measiu'es  directed  at  specific 
groups  of  the  population  and  by  giving  fractional  treatment  to  public  health  problems. 
I  think  there  is  no  service  of  the  Government  more  conscious  of  this  than  the  Public 
Health  Service.  We  have  long  known  and  given  thought  to  the  excessive  mortality 
among  infants  and  to  the  causes  of  maternal  mortality.  A  great  deal  of  our  work  has 
been  directed  toward  these  lines.  It  has  not  been  so  specifically  directed  as  in  the 
case  of  the  Children's  Bureau  whose  only  job  is  to  look  out  after  this,  but  out  work 
deals  with  the  very  fundamentals  of  the  protection  of  maternal  and  infant  life,  with- 
out which  we  can  not  hope  to  achieve  substantial  results.  It  has  covered  a  broader 
and  more  diverse  field.  But,  nevertheless,  we  have  given  a  great  deal  of  attention 
to  this  specific  phase. 

I  do  not  believe  that  it  is  generally  known  that  the  ver>'  first  baby  saving  exhibition 
,  in  the  United  States  was  conceived  and  directed  by  an  officer  of  the  Public  Health 
iService  in  1909.  The  very  first  documents  which  were  published  by  the  Federal 
'Government  which  dealt  vnth  the  special  problems  of  infant  mortality  were  pub- 
lished by  the  Public  Health  Service.     I  refer  %p  "Milk  and  its  relation  to  public 


I 


196  PUBLIC  PKOTECTION   OF  MATERNITY  AND  INFANCT. 

health.."  It  contains  a  very  extensive  monograph  on  infant  feeding  and  infant 
mortality.  Our  work  as  far  as  it  has  gone  has  provided  a  number  of  publications  upon 
this  and  relative  subjects,  of  which  these  I  have  before  the  committee  are  a  partial 
exhibit.  Every  one  of  them  that  I  have  here  contains  work  which  bears  either 
directly  or  indirectly  upon  the  problems  of  maternal  and  child  life.  So  far  as  the 
present  activities  of  the  Public  Health  Service  are  concerned  in  this  matter  of  pro- 
tection of  maternal  and  child  life,  we  have  realized  that  the  only  way  you  are  going 
to  get  adequate  protection  for  them  in  this  country  is  to  create  in  the  State  and  in  the 
local  communities  the  means  by  which  you  are  going  to  protect  the  lives  of  the  mothers 
and  babies.  To  that  end  what  we  have  done  with  all  our  energies  and  with  the  small 
funds  at  our  disposal  is  to  stimulate  the  State  and  the  communities  to  carry  this  work 
on.  For  instance,  last  year  we  aided  directly  in  estabhshing  in  seven  States  depart- 
ments of  child  hygiene  in  States  which  up  to  that  time  did  not  have  funds,  and  the 
result  of  that  work  has  been  very  substantial. 

Take  the  little  State  of  Delaware,  the  second  smallest  State  in  the  United  States. 
As  a  result  of  the  work  of  the  Public  Health  Service  in  that  State,  it  appropriated 
$120,000  to  support  the  work  for  child  and  maternal  welfare  for  two  years,  or  at  the 
rate  of  $60,000  a  year;  although  more  could  be  spent  to  advantage  than  was  appropri- 
ated by  the  legislature  yet  I  think  that  was  a  substantial  appropriation  for  a  State 
the  size  of  Delaware  to  make .  It  was  the  direct  result  of  the  work  of  the  Public  Health 
Service  in  directing  and  organizing  a  child  gygiene  division  in  the  States. 

Again,  in  the  State  of  Missouri,  at  the  invitation  of  the  governor  of  the  State,  we  did 
"work  there.  They  had  passed  a  law,  a  very  excellent  law,  providing  for  a  department 
of  health  in  the  State,  in  which  was  to  be  included  a  division  of  child  hygiene,  and 
wanted  our  aid  in  organizing  it.  We  went  ahead  and  made  a  study  of  maternal  and 
child  health  in  the  State  of  Missouri,  and  as  a  result  of  that  work,  they  appropriated 
for  a  department  of  child  hygiene  in  that  State.  A  very  important  feature  of  that  work 
was  the  care  that  was  taken  to  establish  child  health  centers  that  had  for  their  object 
giving  direct  instructions  to  expectant  mothers,  and  after  the  babies  were  born  to 
teach  the  mothers  how  to  keep  those  babies  well.  I  think  that  we  established  some 
15  or  20  of  these  centers  throughout  the  State.  I  am  looking  here  in  my  papers  for  a 
progress  report  that  was  published  in  the  weekly  Public  Health  reports  of  progress 
of  the  work,  but  I  have  so  much  here  that  I  am  afraid  I  have  misplaced  it. 

For  instance,  one  of  the  very  first  activities  in  the  State  of  Mississippi,  where  we 
organized  this  year  a  department  of  public  health,  was  to  see  what  could  be  done 
toward  placing  the  midwives  of  the  State  under  some  form  of  supervision,  so  that 
those  who  did  insist  on  employing  midwives  would  be  sure  that  the  midwives  had  a 
certain  amount  of  training,  and  to  give  them  certain  attention.  That  was  one  of  the 
very  first  evils  in  the  State  which  our  officer,  who  went  down  there  to  cooperate  with 
the  State  board  of  health,  set  herself  about  to  correct  as  soon  as  she  was  on  the  job. 

Besides  this  very  important  aid  given  the  States  in  organizing  departments  of  child 
hygiene  and  creating  facilities  for  the  care  of  expectant  mothers,  and  the  protection 
of  the  health  of  the  new-born  child,  we  have  also  carried  on  a  large  number  of  studies 
in  oral  hygiene,  school  hygiene,  and  mental  hygiene,  with  relation  to  children's 
nutrition,  such  as  various  studies  of  milk  in  the  feeding  of  infants,  with  respect  to  the 
value  of  raw  milk  and  pasteurized  milk  in  the  feeding  of  infants,  and  a  great  many 
investigations  of  that  kind  have  a  direct  bearing  upon  the  conservation  of  child  life. 

For  instance,  in  oral  hygiene  we  have  had  an  oral  hygiene  unit,  consisting  of  a  dental 
surgeon  and  an  oral  hygienist,  studying  oral  hygiene  among  the  children  of  several 
States.  This  work  was  done  at  the  request  of  the  State  and  local  health  ofiicers. 
As  a  result  of  the  work  of  this  unit,  a  number  of  local  oral  hygiene  imits  have  been 
established,  supported  by  funds  from  the  local  communities,  having  for  their  object 
the  improvement  of  oral  hygiene  among  the  children  of  the  commimity.  As  you 
know,  it  is  only  within  recent  years  that  we  have  realized  the  grave  effects  upon  the 
public  health,  especially  upon  the  health  of  children,  of  bad  mouth  conditions. 

Mr.  HuDDLESTON.  I  would  like  to  know  whether  your  publications  are  intended 
for  general  circulation  or  intended  for  physicians. 

Dr.  ScHEREscHEWSKY.  Our  publications  are  intended  for  at  least  three  or  four 
groups  of  persons.  First  of  all,  when  we  deal  with  a  highly  technical  or  scientific 
subject  which  is  practically  applied  by  technical  ofiicers,  we  publish  those  bulletins 
which  are  circulated  among  this  particular  audience.  Then  there  are  the  publica- 
tions designed  to  convey  information  to  those  who  practically  apply  the  health  laws; 
I  mean  those  having  to  do  the  public  health  business  of  this  country,  State,  local,  and 
coimty  health  officers  who  are  the  persons  who  protect  the  health  of  the  people  along 
the  line  of  actual  applied  sanitary  science.  The  kind  of  information  printed  for  these 
persons  reaches  them  generally  thi'ough  our  public  health  reports.  Moreover,  we  have 
what  are  called  public-health  bulletins  written  in  language  that  anybody  may  under- 


._, 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  197 

stand.  These  so  to  a  large  and  varied  clientele,  chiefly  persons  who  are  interested  in 
public-health  work,  persons  in  volunteer  health  associations,  nurses  and  persons  who 
make  the  pursuit  of  public  health  their  business  in  life.  Then,  we  have  our  popular 
bulletins  which  are  distributed  to  the  general  public,  and,  of  course,  you  understand 
we  run  a  very  large  information  service.  We  receive  I  do  not  know  how  many  letters 
a  day  from  persons  all  over  the  country,  asking  for  information  in  regard  to  public- 
health  matters,  among  which  are  very  many  queries  as  to  the  matters  of  maternal 
hygiene  and  infant  hygiene.  We  either  send  them  a  short  bulletin  in  popular  lan- 
guage which  we  may  have  ready  for  that  occasion,  or  if  it  happens  to  be  a  specific 
query,  the  information  is  gotten  out  for  them  and  they  are  answered  in  detail, 

Mr.  HuDDLESTON.  Do  you  undertake  to  answer  specific  inquiries? 

Dr.  ScHERESCiiEwsKY.  Yes,  sir;  on  any  public-health  question.  We  do  not  tell 
them  how  to  treat  disease. 

Mr.  HuDDLESTON.  Where  they  write  asking  what  to  do  for  certain  ailments,  you  do 
not  tmdertake  to  answer  that? 

Dr.  ScHERESCHEWSKY.  We  do  not  undertake  that.  First  of  all,  long-distance  diag- 
nosis is  not  reliable.  We  tell  the  writer  to  go  and  consult  a  good  physician.  We  do 
not  imdertake  to  give  mail  treatment  for  disease.  But  we  give  adA'ice  on  public- 
health  questions  and  give  them  answers  to  questions  on  personal  hygiene. 

^Ir.  HuDDLESTo.v.  Do  you  undertake  to  tell  how  a  man  may  keep  himself  from  con- 
tracting tuberculosis? 

Dr.  iScHEREscHEWSKY.  Indeed  we  do. 

Mr.  HuDDLESTON.  But  if  he  should  have  tuberculosis,  you  would  not  undertake 
that. 

Dr.  ScHERESCHEWSKY.  We  would  not  undertake  to  treat  him;  no.  But  we  could 
give  general  advice  directed  to  the  cure  of  tuberculosis. 

^Ir.  HuDDLESTOX.  You  have  your  popular  publications? 

Dr.  ScHERESCHEWSKY.  Yos,  sir.  We  tell  him  precautions  to  take  in  order  to  pre- 
vent transmission  of  the  disease  to  others  and  tell  Mm  of  his  chances  of  recovery, 
which  would  be  verj^  good  provided  he  lived  the  proper  life  and  took  medical  advice, 
and  80  forth.  We  would  cheer  him  up.  But,  of  course,  we  would  not  undertake  to 
give  him  treatment  for  his  condition.  That  would  be  foolish.  We  would  not  know 
what  was  the  matter,  and  in  the  second  place,  I  do  not  know  that  it  is  the  business  of 
the  Federal  Government  to  furnish  treatment  to  the  private  indi\T-dual,  but  it  is  our 
business  to  disseminate  useful  information. 

Ml-.  HuDDLESTON.  It  is  not  my  purpose  to  divert  you. 

Dr.  ScHERESCHEWSKY.  I  have  not  very  much  more  to  say  in  regard  to  this  matter 
except  to  emphasize  the  fact  that  we  have  had  a  great  deal  of  talk  about  the  protection 
of  child  and  maternal  life  being  a  sociological  question.  It  is  not.  People  do  not 
die  of  sociological  conditions.  They  die  of  actual  ailments.  Of  course,  nobody  will 
deny  that  sociological  conditions  have  an  important  effect  upon  the  condition  of 
health  of  the  individual.  If  a  person  can  not  get  any  food,  of  course,  he  will  starve 
to  death.  In  the  winter  time  if  he  can  not  ^et  adequate  clothing  and  shelter  he  is 
ver\'  likely  to  suffer  from  the  effects  of  the  cold  weather  in  the  form  of  pneumonia  or 
diminished  \dtality  that  causes  him  to  be  a  prey  to  infestion.  Of  coui'se,  there  is  a 
sociological  side  to  the  question.  But  there  are  only  two  ways  in  which  you  are 
going  importantly  to  effectively  protect  the  lives  and  health  of  the  people.  In  the 
first  place  you  would  if  you  could  get  it,  give  them  money  enough  to  buy  all  they  de- 
sire. That,  of  course,  is  absurd.  The  question  then  becomes  one  of  proper  public- 
health  protection,  leaving  the  individual  to  work  for  himself  under  optimum  health 
conditions.  You  can  do  that.  You  can  go  ahead  with  those  measures  which  will 
protect  the  health  of  the  people.  Those  are  not  sociological  measures;  they  are  public- 
health  measures,  medical  measures,  and  eveiy  public-health  measui'e  of  any  conse- 
quence, or  ever}-  efficient  measure  that  we  know  for  the  protection  of  the  public  health 
is  directed  by  physicians  and  their  aids. 

Mr.  HuDDLESTON.  With  reference  to  your  publications,  tell  us  what  is  your  annual 
appropriation  for  publications,  so  that  we  may  get  some  idea  of  the  scope  of  your 
actiAdties. 

Dr.  ScHERESCHEWSKY.  I  caii  not  give  you  those  exact  figures  because  the  annual 
appropriation  for  printing  is  not  under  the  control  of  my  diAision.  We  have  some 
$125,000  for  printing. 

Mr.  HuDDLESTON.  You  have  issued  many  of  them  during  the  last  10  years. 

Dr.  ScHERESCHEWSKY.  Last  year  I  think  we  published  something  like  13,000,000 
pamphlets.  Of  course,  the  Joint  Committee  on  Printing  thinks  we  have  been  pub- 
lishing too  much.  In  fact.  Senator  Smoot  thought  our  health  almanac  was  an  improper 
use  of  Government  funds,  and  I  know  that  we  have  cut  down  in  our  printing  now  in 
amount. 


198  PUBLIC  PROTECTIOlSr   OF  MATERNITY  AND  INTANCY. 

Mr.  HuDDLESTON.  That  number  of  pamphlets  gives  an  idea  of  it. 

Dr.  SCHERESCHEWSKY.  We  distribute  Something  like  13,000,000  pamphlets  annually 

Mr.  Barkley.  How  many  separate  pamphlets  does  that  include? 

Dr.  SCHERESCHEWSKY.  I  could  uot  say.  I  have  here  a  list  of  our  publications 
up  to  April,  1921,  and  I  judge  there  are  in  our  total  publications  probably  1,000  differ- 
ent titles  of  one  kind  or  another.  For  instance,  there  are  supplements  of  public 
health  reports,  46;  Keepwell  series,  12;  miscellaneous  publications,  26;  posters,  15; 
reprints  of  public  health  reports,  643,  etc. 

Mr.  HuDDLESTON.  Ouc  thousand  different  publications  a  year. 

Dr.  SCHERESCHEWSKY.  Not  SO  many  as  that;  150  different  publications  a  year;  I 
have  not  tabulated  them. 

The  Chairman.  Have  you  any  further  statement.  Doctor? 

Dr.  SCHERESCHEWSKY.  No,  I  have  not  much  further,  except  the  general  statement 
that  this  matter  is  a  public  health  problem,  and  it  is  my  belief  that  it  should  be  ad- 
ministered by  those  who  know  public  health. 

Mr.  Mapes.  I  would  like  to  get  your  opinion  as  to  the  relative  importance  of  these 
pamphlets  that  you  have  been  speaking  of  and  the  personal  work  that  i^  done  by  yom* 
service. 

Dr.  SCHERESCHEWSKY.  I  do  not  quite  get  the  significance  of  that  question.  Of 
course,  our  object  in  printing  these  documents  is  to  inform  the  general  public.  But 
they  are  not  sent  indiscriminately.  Many  of  these  documents  that  are  printed,  when 
we  are  doing  work  in  a  State,  are  distributed  through  the  State  agency  to  persons 
whom  they  wish  particularly  to  influence  in  the  course  of  the  work. 

Mr.  Mapes.  This  is  what  I  have  in  mind.  I  do  not  know  but  what  you  have  an- 
swered it.  You  print  these  documents  and  you  do  not  know  who  reads  them  or  how 
many  of  them  are  read. 

Dr.  SCHERESCHEWSKY.  A  great  many  are  sent  in  direct  response  to  inquiries  we 
receive. 

Mr.  Mapes.  That  is  quite  a  common  practice,  for  Government  bureaus  to  issue 
circulars,  and  I  wanted  to  get  your  judgment  as  to  how  important  you  consider  those 
as  compared  with  the  work  done  by  your  personal  representatives  you  send  into  the 
State. 

Dr.  SCHERESCHEWSKY.  I  feel  that  the  work  of  our  personal  representatives  who  go 
into  the  State  at  the  request  of  the  State  health  authorities  to  organize  the  work  is 
very  much  more  important  than  the  mere  scattering  of  documents  broadcast  through 
the  land.  But  the  point  is  this.  These  men  who  go  into  the  States  have  the  means 
of  placing  these  documents  in  the  hands  of  interested  individuals  who  will  read  them 
and  see  where  they  are  doing  good.  For  instance,  there  is  our  news  service  that 
Miss  Kilbreth  mentions,  which  goes  into  the  patent  insides  of  I  do  not  know  how 
many  different  country  newspapers  and  are  read  with  the  rest  of  the  news  inside  there 
and  become  the  object  of  discussion,  so  that  very  frequently  we  get  at  the  Bureau 
of  the  Public  Health  Service  inquiries  which  are  generated  by  those  very  articles 
published  in  the  papers,  saying,  "We  read  it  in  the  paper  and  would  like  to  get  a 
few  more  details  from  you  in  regard  to  it." 

Mr.  Mapes.  You  have  studied  this  particular  bill? 

Dr.  ScHEKESCHEWSKY.  Ycs,  sir. 

Mr.  Mapes.  Just  to  what  extent  is  the  Public  Health  Service  doing  the  work  that 
this  bill  proposes  that  the  Children's  Bureau  shall  do? 

Dr.  SCHERESCHEWSKY.  I  gavc  the  committee  the  extent  of  what  we  were  doing  in 
this  way,  that  we  had  cooperated  during  the  past  fiscal  year  in  aiding  seven  States 
to  establish  a  division  of  child  hygiene  and  are  working  in  two  States  now.  We  do 
not  get  any  great  amount  of  money  that  can  be  spent  in  this  way,  and  we  try  to  make 
it  go  as  far  as  we  can. 

Mr.  Mapes.  In  order  to  properly  do  the  work,  is  it  necessary  to  have  an  appropria- 
tion which  will  enable  you  to  send  representatives  into  each  individual  State? 

Dr.  SCHERESCHEWSKY.  Yes.  It  would  be  a  great  advantage  to  have  a  representa- 
tive from  the  Public  Health  Service  to  cooperate  in  the  State  with  the  State  health 
authorities  by  aiding  those  State  authorities  to  establish  for  themselves  an  adequate 
system  in  their  State. 

Mr.  Mapes.  This  bill,  of  course,  provides  for  a  direct  contribution  to  the  State? 

Dr.  SCHERESCHEWSKY.  Yes.  sir. 

Mr.  Mapes.  There  was  a  distinguished  witness  before  the  committee  yesterday, 
who  said  in  substance,  if  I  understood  his  testimony  correctly,  that  he  doubted  the 
necessity  of  a  contribution  to  the  State,  but  that  he  thought  it  was  advisable  to  have 
the  Government  show  the  way.'  I  am  not  trying  to  quote  him  at  all,  but  only  to 
^ive  the  substance  of  his  testimony,  and  if  the  Government  did  point  out  the  way, 
that  it  would  stimulate  the  States  and  shame  them,  so  to  speak,  into  taking  care  of 


PUBLIC  PROTECnON  OP  MATERNITY  AND  INFANCY.  199 

the  work  provided  for  in  this  bill  without  any  direct  contribution  from  the  National 
Treasury.    What  is  your  judgment  about  it? 

Dr.  ScHERESCHEwsKY.  My  judgment  is  that  the  Federal  Government  has  a  cer- 
tain responsibility  for  the  care  and  health  of  its  citizens.  It  is  not  wholly  responsible, 
for  the  local  community  has  the  greatest  responsibility  of  all,  nor  for  the  same  reason 
is  it  the  responsil>iIity  of  the  State,  which  has  its  own  definite  responsibility.  I 
believe  the  Government  should  participate  in  the  protection  of  the  public  health  of 
the  United  States,  but  only  to  the  extent  which  corresponds  with  its  joint  responsi- 
bilities with  States  and  local  communities. 

There  is  one  other  thing.  The  Government  certainly  can  and  does  in  many  other 
activities  exercise  a  powerful  stimulation  in  leadership  for  the  State  and  local  com- 
munity, to  get  the  State  and  community  to  act  for  itself  in  protecting  the  life  and 
health  of  its  citizens.     It  does  that  in  other  things. 

Mr.  M.vpES.  Has  the  Public  Health  Service  got  the  organization,  if  the  funds  were 
provided,  so  that  it  could  expand  sufficiently  to  take  care  of  this  identical  work? 
Dr.  ScHERESCHEWSKY.  Yes.  sir;  unqiiestionably. 

Mr.  M.VPES.  It  wo\ild  be  only  a  question  of  making  the  appropriation  to  enable 
the  Public  Health  SerAdce  to  do  this  work  and  point  out  the  way  for  the  States? 

Dr.  ScHERESCHEWSKY.  Yes,  sir;  absolutely.     For  years  we  have  been  cooperating 
with  the  States.    Without  seeming  to  indulge  in  le\ity,  I  may  say  that  cooperation 
with  the  States  is  the  middle  name  of  the  Public  Health  Service.     That  has  been  our 
special  duty,  to  cooperate  with  the  States,  and  they  all  know  ixs  and  have  confidence 
in  us.     They  know  that  we  know  just  exactly  how  the  Federal  authority  comes  in 
their  States  and  where  the  Federal  authority  ends  and  States'  rights  begins. 
Mr.  Mapes.  How  much  would  the  overhead  be  increased? 
Dr.  ScHERESCHEWSKY.  The  overhead  of  the  Public  Health  Service? 
Mr.  M.VPES.  Yes. 

Dr.  ScHERESCHEWSKY.  It  would  not  be  increased  very  much.  The  actual  over- 
head of  our  bureau  is  low — we  have  the  lowest  overhead  of  any  Government  service — 
in  my  own  particular  division,  where  we  decentralize  our  work,  the  entire  oflBce  per- 
flonnel  of  my  own  diAT-sion  is  seven.     It  is  not  a  heavy  overhead. 

Mr.  Mapes.  The  Children's  Bureau,  as  I  understand  it,  is  getting  out  some  bulle- 
tins along  the  same  line  that  your  organization  is? 
Dr.  ScHERESCHEWSKY.  Yes,  sir. 

Mr.  Mapes.  Is  it  doing  any  other  work  for  the  education  of  the  people  in  the  care 
of  maternity  and  infancy? 

Dr.  ScHERESCHEWSKY.  I  am  not  fully  acquainted  with  all  the  work  of  the  Chil- 
dren's Bureau.  I  hope  I  have  not  created  the  impression  that  I  am  belittling  the 
Children's  Bureau  or  accusing  them  of  duplication.  As  a  matter  of  fact,  we  do  not 
begin  to  cover  our  field,  either  one  of  us,  for  that  matter.  And  while  the  Children's 
Bureau  and  the  Public  Health  Service  are  in  many  instances  doing  the  same  kind  of 
work,  our  tracks  have  not  crossed. 

Mr.  Mapes.  That  is  a  very  commendable  spirit.  I  was  not  asking  my  question 
for  the  purpose  of  criticism,  but  for  the  purpose  of  obtaining  information. 

Dr.  ScHERESCHEWSKY.  No.  The  Public  Health  Service  and  the  Children's 
Bureau  are  doing  identical  work.  In  other  words,  I  know  the  Children's  Bureau 
has  relations  with  the  State  departments  in  child  hygiene  and  so  have  we.  Both  of 
lis  try  to  help  them  out.  We  are  Goverimient  sei"v^ants  here  and  the  Government 
serves  the  public. 

Mr.  Mapes.  Should  we,  if  we  could  eliminate  that  duplication,  put  it  all  into  the 
hands  of  one  service? 

Dr.  ScHERESCHEWSKY.  If  you  want  to  be  logical,  I  would  say  that  all  health  mat- 
ters should  be  under  the  direct  charge  of  one  Government  agency;  in  the  interests  of 
efficiency  no  other  answer  is  possible.  Of  course,  Congress  in  its  wisdom  will  do 
■exactly  as  it  wants  to  in  regard  to  that  matter. 

Mr.  Mapes.  In  your  opinion,  is  there  such  an  eagerness  on  the  part  of  the  States 
now  to  take  up  this  work  and  provide  for  the  education  of  the  people  in  maternity 
and  infant  care  that  if  the  way  could  be  properly  pointed  out  to  do  it,  they  would 
■do  it  themselves  without  any  direct  aid  from  the  Federal  Government? 

Dr.  ScHERESCHEWSKY.  I  think  that  some  form  of  aid  from  the  Federal  Government 
would  be  a  stimulus  imdoubtedly.  This  movement  for  the  protection  of  maternal 
and  child  life  is  now  in  the  popular  mind  and  measures  for  its  protection  would  doubt- 
less be  generally  adopted  after  a  while.  We  can  aid  them  and  stimulate  them  by 
judicious  Federal  aid  and  bring  about  a  result  which  if  left  to  the  process  of  natural 
evolution  would  take  a  great  many  years  to  accomplish.  We  could  certainly  hasten 
the  day  when  the  public  measures  which  the  State  or  community  ought  to  take  for 
the  protection  of  child  and  maternal  life  will  be  taken.    But  I  am  afraid  that  what 


200  PUBLIC  PROTECTIOlir  OF  MATERlvriTY  AITD  INFANCY. 

I  have  not  made  clear  is  this,  that  I  do  not  think  that  we  ought  to  legislate  specifically 
for  one  group  of  the  population,  when  as  a  matter  of  fact  the  result  attained  will  be 
better  attained  by  a  general  health  program.  The  proponents  of  this  bill  may  say, 
"This  is  a  sociological  measure";  "we  don't  intend  to  do  any  medical  work,"  etc., 
and  that  25  per  cent  of  the  appropriation  is  to  be  devoted  to  educational  work.  But 
I  want  to  say  this.  If  the  bill  is  passed,  as  soon  as  they  get  practical  experience  in- 
working  under  this  bill,  I  will  bet  a  dollar  to  a  doughnut,  that  every  plan  which  is 
submitted  for  approval  by  a  State  for  the  protection  of  child  and  maternal  life,  will 
involve  a  general  health  program  and  practically  nothing  else,  and  I  will  bet  my  last 
cent  on  that. 

Mr.  Mapes.  Would  you  also  bet  that  the  State  would  select  the  Public  Health- 
Service  to  put  it  into  effect? 

Dr.  ScHERESCHEWSKY.  I  do  not  know  about  that.  The  Public  Health  Service  is 
ready  to  cooperate  at  any  time  with  the  Children's  Bureau  to  its  fullest  ability. 

(Thereupon,  at  5.15  o'clock  p.  m.,  the  committee  adjourned  to  meet  again  at  10' 
o'clock  a.  m.,  Saturday,  July  23,  1921.) 


Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives, 

Saturday,  July  23,  1921. 
The  committee  met  at  10  o'clock  a.  m.,  Hon.  Samuel  E.  Winslow  (chairman)  pre- 
siding. 

The  Chairman.  If  the  members  of  the  committee  will  kindly  give  their  attention,, 
we  will  proceed  with  the  further  consideration  of  the  so-called  Sheppard-Towner  bill.. 
The  Chair  will  call  on  Col.  Keiley  as  the  first  person  to  make  a  statement  this  morning. 

STATEMENT  OF  COL.  C.  B.  KEILEY,  OF  RICHMOND,  VA. 

The  Chairman.  Colonel,  will  you  kindly  give  your  name,  your  home  address,  and' 
what  or  whom  you  represent. 

Col.  Keiley.  C.  R.  Keiley,  Richmond,  Va. 

The  Chairman.  I  do  not  want  to  clip  your  wings  at  all.  Colonel,  but  we  have  only 
this  morning  for  this  side  and  if  you  can  be  reasonably  brief  the  committee  will  try 
to  read  between  the  lines. 

Col.  Keiley.  Mr.  Chairman  and  gentlemen  of  the  committee:  During  the  war  and' 
now 

Mr.  Newton  (interposing).  Colonel,  in  connection  with  giving  your  name,  will  you 
also  state  your  line  of  business. 

Col.  Keiley.  I  am  going  to  give  that  now.  During  the  war  and  since,  because  ouf 
council  is  still  functioning,  I  was  the  executive  officer  of  the  Virginia  Council  of 
Defense.  Our  State  council  of  defense  was  a  peculiar  body  in  that  it  consisted  of 
every  chief  of  department  in  the  State  of  Virginia,  and  one  of  our  prime  matters  of 
concern  dming  the  war  was  the  conservation  of  public  health,  and  as  the  executive 
officer  of  the  Council  of  Defense  I  was  in  touch  with  all  the  health  efforts  of  all  kinds  in 
the  State  of  Virginia;  in  some  instances,  I  may  say,  directing  them. 

I  found  at  that  time  that  there  was  apt  to  be  a  great  deal  of  difficulty  in  managing, 
health  matters  when  one  health  department,  you  might  say,  was  under  one  agency, 
and  another  health  department  under  another  agency.  For  instance,  our  social 
hygiene,  or  what  we  call  our  V.  D.  Bureau  was  under  the  War  Camp  Community 
Service  or  under  the  National  Commission  on  Training  Camp  Activities.  We,  in 
Virginia  had  very  Uttle  trouble  after  a  few  weeks,  although  that  particular  branch  of 
work  would  naturally  in  our  State  fall  under  our  commissioner  of  charities  and  cor- 
rection, because  it  was  largely  corrective  work;  but  we  were  able  through  the  Council 
of  Defense,  the  commissioner  of  chairities  was  a  member  as  well  as  the  health  commis- 
sioner, to  make  our  plans  so  they  did  not  conflict. 

My  prime  objection  to  the  Sheppard-Towner  bill  is  that  the  control  of  the  work  is 
badly  placed.  It  seems  to  me  to  be  distinctly  a  pubUc  health  measure,  and  if  it  is  tO' 
be  a  public  health  measure  it  should  with  the  United  States  Public  Health  Service. 
We  have  had  in  Virginia  a  very  agreeable  relation  with  the  Public  Health  Service. 
The  former  surgeon  general,  Rupert  Blue,  some  time  ago — was  it  three  years  ago  or 
four  years  ago,  Doctor? 

Dr.  Schereschewsky.  Three  years  ago. 

Col.  Keiley.  Three  years  ago  made  arrangements  with  us  for  cooperative  public- 
health  work  in  our  State.  I  was  reading  an  account  some  time  ago  of  one  of  the  hearings- 
before  this  committee  where  some  one  said  that  less  than  3  per  cent  of  the  rural  United 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  201 

States  had  adequate  local  public  health  service.  Gentlemen,  I  am  not  surprised. 
We  had  less  than  that  in  Virginia  three  years  a<?o  when  this  matter  was  started;  but 
through  a  cooperative  plan,  working  the  United  States  Public  Health  Service  and  the 
State  Board  of  Health,  and  the  Council  of  Defense  of  Virginia— these  were  the  three 
agencies  combined  in  it — we  have  gotten  in  11  counties  of  Virginia  a  fairly  adequate 
health  service,  in  four  or  five  counties  a  very  adequate  health  service,  and  we  nave 
very  largely  improved  health  conditions  throughout  the  State;  very  largely  improved 
them. 

Furthermore,  we  have  done  something  which  a  few  years  ago  seemed  to  be  in- 
credible. We  have  made  the  legislators  and  the  country  people  of  Virginia  take 
such  an  interest  in  public  health  work  tliat  they  are  willing  to  make  appropriations 
for  cooperative  health  work. 

Gentlemen,  you  know  that  you  have  no  money  tree  here  in  Washington.  Money 
does  not  grow  on  trees  to  be  shaken  off  as  the  leaves.  You  tax  us  in  the  States  to  get 
the  money  to  appropriate.  It  seems  to  me  a  manifest  unfairness  to  use  the  taxes  of 
the  State  for  a  specialized  purpose  and  in  a  way  that  we  tliink  is  incorrect,  and  then 
tell  us  that  we  have  got  to  tax  ourselves  additionally  in  order  to  meet  a  tax,  part  of 
which  you  are  giving  back  to  us,  or  else  allow  our  money  to  go  to  another  State.  We 
do  not  think  it  fair. 

All  of  us  are  interested  in  maternity  work.  I  think  nothing  of  the  argument  that 
only  a  small  portion  of  the  population  is  affected,  because  at  some  period  of  our  lives 
all  of  us  are  infants,  and  a  very  material  proportion  of  the  population  is  at  one  time 
or  another  a  mother,  so  that  that  argument  does  not  appeal  to  me  at  all,  but  rather 
the  uneconomic  aspect  of  the  case,  the  financial  unsoundness  of  the  proposition  of 
trying  to  put  in  counties  that  have  the  greatest  diflBculty  in  raising  $2,500  or  $3,000 
a  year  for  public  health  work,  and  then  only  through  private  subscriptions — to  try 
to  create  a  highly  specialized  department  with  somebody  for  this  subject  and  some- 
body for  that  subject,  and  somebody  for  another  subject,  no  matter  how  important 
it  may  be. 

They  are  vay  main  objections  to  this  bill.  We  have  in  Virginia  ouj;  local  problems. 
We  have  not  the  problems  in  Virginia  that  Maine  has.  They  have  problems  that 
come  from  a  cold-weather  country,  so  has  Minnesota.  We  have  problems  that  arise 
in  a  territory  that  is  warm  and  where  we  live  outdoors  most  of  the  year.  In  other 
words,  to  be  perfectly  plain,  we  have  intestinal  parasite  troubles  in  Virginia.  The 
mother  who  has  hookworm,  the  mother  who  has  dysentery  or  diarrhea  or  who  has 
pellagra;  the  mother  who  is  affected  with  any  one  of  the  diseases  that  come  from  the 
intestinal  parasites  or  fi'om  malnutrition  or  any  other  weakening  proposition,  is  cer- 
tainly going  to  be  a  rather  hazardous  mother.  Her  health  will  be  affected  and  the 
health  of  her  child  will  be  affected,  and  therefore,  gentlemen — and  I  am  taking  the 
advice  of  Col.  Winslow  and  making  this  statement  brief — I  have  no  objection  at  all 
to  the  Sheppard-Towner  bill  or  to  Judge  Towner's  bill,  as  a  bill,  but  I  think  with  this 
bill  you  will  waste  money,  because  less  money  would  produce  probably  four  or  five 
times  as  great  an  expenditure  tliroughout  the  States,  because  it  would  have  the 
sympathy  of  the  State  and  of  the  State  legislature. 

I  thank  you,  gentlemen. 

The  Chairman.  Does  any  member  of  the  committee  desire  to  question  the  witness? 
If  not,  we  thank  you  very  much.  Colonel,  for  coming  here. 

Is  Mrs.  Lockwood  here?  [After  a  pause.]  Apparently,  Mrs.  Lockwood  is  not  here 
yet. 

Will  Dr.  Martin  please  testify  next?  [After  a  pause.]  Dr.  Martin  is  not  here  at  this 
time.     Is  Dr.  Williams  present? 

Dr.  Williams.  Yes,  sir. 

STATEMENT  OF  DR.  E.  G.  WILLIAMS,  STATE  HEALTH  COMMIS- 
SIONER OF  VIRGINIA,  RICHMOND,  VA. 

The  Chairman.  Doctor,  please  give  your  name,  address,  and  what  or  whom  you 
represent. 

Dr.  Williams.  Dr.  E.  G.  Williams,  State  health  commissioner  of  Virginia.  Mr. 
Chairman,  I  do  not  want  to  be  considered  in  opposition  to  this  bill.  As  a  member  of 
the  executive  committee  of  the  Conference  of  State  Health  Officers,  when  this  matter 
was  brought  to  our  attention,  I  voted  in  favor  of  appro\'ing  this  bill  because  I  consider 
that  this  bill  is  a  great  step  in  advance  over  present  conditions.  All  approvals  are 
relative.  I  am  a  great  believer  in  getting  what  you  can  when  it  is  an  improvement  on 
existing  conditions,  but  if  it  be  possible  to  improve  this  measure,  to  make  it  more 
suitable  to  the  real  needs  of  the  people,  I  think  that  should  be  done. 

In  the  hearings  you  have  doubtless  heard  much  in  favor  of  this  bill ,  and  I  will  not 
go  into  that  but  will  presume  that  what  you  want  is  criticism  of  the  bill  to  show  how 
it  may  possibly  be  improved. 


202  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

The  bill  only  deals  with  one  of  the  many  phases  of  public  health  work.  The  needs 
of  different  communities  vary.  The  needs  of  the  same  community  at  different  times 
vary.  Public  health  should  be  developed  logically  and  in  an  orderly  manner,  ac- 
cording to  the  relative  needs  of  those  conamunities. 

I  should  like  to  cite  an  illustration  of  just  what  I  mean.  In  the  year  before  the 
war  the  superintnedent  of  a  large  manufacturing  plant,  that  had  settled  in  a  community 
and  that  had  built  up  around  it  quite  a  settlement,  came  up  to  the  State  board  of 
health  and  asked  if  we  could  not  help  him ,  and  stated  that  there  was  so  much  sickness 
among  his  employees  that  some  of  his  machines  were  always  idle  on  account  of  sick 
employees. 

We  made  an  investigation  of  conditions  in  that  community  and  told  him  we  could 
help.  We  sent  a  man  there  and  the  company  said  that  they  would  do  whatever  was 
recommended.  The  result  was  that  the  following  year  the  manager  came  up  to  the 
office  again  and  said  that  he  came  up  to  express  his  appreciation  for  what  the  health 
department  had  done  for  his  community,  and  stated  that  whereas  in  the  previous 
year  his  work  was  seriously  handicapped  by  illness  and  some  of  his  machines  always 
idle,  because  he  could  not  get  enough  employees  on  account  of  the  sickness  of  them- 
selves or  their  families,  that  after  this  work  had  been  done  he  had  all  the  help  he 
wanted;  that  none  of  his  machines  had,  during  the  previous  summer,  been  idle  on 
account  of  sickness;  that  the  laborers  were  healthy,  contented,  and  happy,  and  were 
willing  to  stay  witii  him,  notwithstanding  the  fact  that  that  year  was  the  year  the 
war  had  begun,  and  the  Government  was  offering  big  wages  to  induce  laborers  to  do 
Government  work.  The  needs  of  that  community  were  fundamental  needs,  a  safe 
water  supply  and  safe  disposal  of  human  filth,  and  to  get  rid  of  conditions  that  were 
breeding  mosquitoes.     That  was  the  work  which  we  did  there. 

This  simply  shows  what  can  be  done  by  logical  development  and  by  meeting  the 
needs  of  the  people.  How  useless  it  would  have  been  in  that  community  to  have  put 
in  a  maternity  or  a  welfare  department.  There  are  some  places  where  the  develop- 
ment has  reached  a  stage  where  you  should  put  in  child  welfare  and  maternity  depart- 
ments; but  many  communities,  and  in  fact,  most  of  the  communities,  need  more 
fundamental  features  of  health  work.  It  would  be  almost  like  building  a  city  and 
putting  in  a  hospital  or  a  dispensary  for  infants  and  mothers  before  you  put  in  a  pure 
water  supply  or  a  safe  sewerage  system. 

Therefore,  I  think  if  the  Government  can  help  us,  it  should  be  left  with  the  local 
community  to  put  in  health  work  according  to  the  greatest  needs  in  that  community 
instead  of  supplying  them  with  a  ready-made  plant  and  trying  to  make  it  suit  all 
communities. 

Mr.  Denison.  Then,  Doctor,  you  are  opposed  to  tnis  idea  of  certain  standards 
being  fixed  by  a  bureau  in  Washington  and  prescribed  for  the  different  locaHties? 

Dr.  Williams.  Yes,  sir;  because  the  work  in  the  community  should  be  done  accord- 
ing to  the  greatest  needs  in  that  community. 

Mr.  Denison.  This  bill  has  a  pro\'ision,  as  I  remember  it,  which  requires  that  the 
regulations  or  terms  prescribed  .by  the  bureau  which  handles  it  must  be  accepted; 
or,  to  state  it  in  another  way,  the  plans  provided  by  the  local  community  must  be  ap- 
proved before  they  can  get  any  help.     Are  you  in  favor  of  such  a  provision? 

Dr.  Williams.  I  understand  that  this  is  all  for  maternity  and  infants,  as  I  read 
the  bill. 

Mr.  Denison.  Yes. 

Dr.  Williams.  But,  for  instance,  in  the  community  I  just  referred  to,  could  that 
fund  be  used  for  getting  a  piure  water  supply  and  a  safe  disposal  of  filth?  That  was  the 
greatest  need  in  that  community.  The  work  that  was  done  there  saved  more  Hves, 
mothers  and  infants,  as  well  as  other  people  in  the  community,  than  any  other  one 
thing  could  have  accomplished. 

Do  I  understand  that  this  fund  could  be  used  for  these  general  health  measures 
and  not  limited  to  mothers  and  infants? 

Mr.  Denison.  I  do  not  think  it  could  under  the  provisions  of  the  bill. 

Dr.  Williams.  I  understand  that  is  the  condition. 

Mr.  Denison.  Are  j^ou  opposed  to  this  bill  being  limited  to  this  particular  subject? 

Dr.  Williams.  I  think  it  should  be  broad  enough  to  put  in  those  improvements 
that  the  community  needs  the  most.  Do  you  not  see  that  it  would  be  useless  in 
that  community  to  put  in  infant  and  mother  work  when  this  other  work  would  help 
mothers  and  infants  as  well  as  others? 

Mr.  Denison.  Ydu  are  opposed  to  any  policy  of  Federal  legislation  which  will 
require  that  the  money  appropriated  must  be  used  for  a  single  particular  pu,rpose? 

Dr.  Williams.  I  do  not  oppose  any  health  legislation  when  it  is  an  improvement 
on  what  we  have.     I  simply  prefer  to  have  first  what  is  going  to  help  all  the  people. 

Mr.  Denison.  What  I  am  interested  in  learning  is  whether  you  are  for  or  against 
this  particular  bill? 


PUBLIC  PKOTECTION   OF  MATERNITY  AND  INFANCY.  203 

Dr.  WiLLiAMa.  If  you  dan  not  make  an  improvement  on  this  bill,  the  improvements 
•which  I  think  sliould  be  put  in,  then  give  us  the  bill,  but  I  think  it  would  be  a  wiser 
expenditure  of  money  to  t^et  the  greatest  results  by  giving  greater  latitude  so  that 
you  can  help  otliers  as  well  as  the  mothers  and  infants. 

I  should  like  to  put  in  the  record  a  series  of  resolutions  adopted  recently  in  Boston 
by  the  conference  of  State  health  ofRcers,  as  thoy  have  approved  the  bill. 

The  Chairm.\n.  Will  you  read  them  or  give  them  to  the  reporter  to  be  embodied 
in  the  hearing? 

Dr.  Williams.  I  will  read  only  one  preamble;  I  will  not  read  all  the  preambles. 

The  Chairman.  Very  well. 

Dr.  Williams  (reading): 

"Whereas  (7)  the  health  needs  of  different  localities,  varying  widely  because  of 
difference  in  climatic,  economic,  social,  and  other  conditions,  can  not  be  met 
economically  and  effectively  by  any  higlily  specialized  program  of  health  work : 
Therefore  be  it 

"Resolved  hy  the  conference  of  State  and  Territorial  health  officers  with  the  Public  Health 
Service:  (1)  That  proper  expenditures  for  the  establishment  and  maintenance  through 
out  our  rural  districts  of  local  health  service  with  whole-time  well-qaulified  personnel 
to  carry  out  in  logical  and  advantageous  sequence  the  different  branches  of  health 
work  needed  from  time  to  time  in  the  different  localities  would  accomplish  more  for 
the  national  welfare  than  could  be  accomplished  with  equivalent  expenditures  for 
any  other  purpose. 

"(2)  That  the  application  of  the  principle  of  Federal-aid  extension  to  rural  health 
promotion  is  entirely  logical,  is  consistent  with  the  theory  and  established  practices 
of  our  system  of  Government,  and  is  necessary  to  the  protection,  to  a  reasonable  degree, 
of  our  national  health  interests. 

"  (3)  That  the  cooperation  of  the  Federal  Government  with  State  and  local  agencies 
for  the  promotion  of  rural  health  work  should  be  extended  through  one  Federal  health 
agency  in  one  department  of  the  Federal  Government. 

"(4)  That  of  the  sum  of  about  $20,000,000  a  year  which  eventually  will  be  needed 
to  carry  out  a  reasonably  adequate  program  of  rural  health  work  in  the  United  States 
about  $2,000,000  should  be  furnished  by  the  Federal  Government,  about  $6,000,000 
by  State  governments,  and  about  $12,000,000  by  local  (county,  township,  or  town) 
governments  with  the  financial  assistance  of  private  agencies." 

Mr.  Barkley.  What  did  it  resolve? 

Dr.  Williams.  Those  were  the  resolutions;  I  only  read  one  preamble. 

Mr.  Barkley.  Where  held? 

Dr.  Williams.  Those  were  the  resolutions  adopted  at  the  conference  recently  held 
in  Boston. 

Mr.  Barkley.  WTiat  territory  does  that  conference  represent? 

Dr.  Williams.  The  State  health  officers  of  the  States  of  the  country. 

Mr.  Barkley.  Of  the  United  States? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  Did  that  conference  take  any  action  on  this  particular  bill  one  way 
or  the  other? 

Dr.  Williams.  Not  the  recent  conference.  The  executive  committee  before 
Christmas  had  this  bill  before  it  and  later  in  the  fall 

Mr.  Barkley  (interposing).  What  did  they  do  then? 
.    Dr.  Williams.  They  approved  it. 

Mr.  Barkley.  They  approved  the  bill? 

Dr.  Williams.  Yes,  sir;  the  Sheppard-Towner  bill,  and  at  a  recent  meeting  in 
Washington  the  actions  of  the  executive  committee  were  approved.  These  resolu- 
tions, I  should  mention,  were  passed  on  subsequently. 

Mr.  Barkley.  None  of  these  resolutions  contradicts  their  previous  action  indorsing 
this  bill? 

Dr.  Williams.  As  I  say,  so  far  as  the  Sheppard-Towner  bill  is  concerned,  I  speak 
only  for  myself.  The  approval  of  the  bill  was  relative.  It  is  such  an  improvement  on 
present  conditions,  but  if  the  provisions  can  be  improved,  so  much  the  better.  The 
resolutions  had  no  relationship  to  this  bill. 

Mr.  Barkley.  This  association,  composed  of  the  health  officers  of  the  States,  spe- 
cifically indorsed  the  Sheppard-Towner  bill  last  fall? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  And  they  have  not  rescinded  that  action? 

Dr.  Williams.  No,  sir;  only  this  general  statement  of  principles. 

Mr.  Barkley.  That  is  broader  than  the  work  contemplated  by  this  law? 

Dr.  Williams.  Yes,  sir.  I  think  the  Sheppard-Towner  bill  could  be  amended  so  as 
to  come  within  these  principles;  it  would  be  an  improvement  on  the  Sheppard-Townei 
bill. 


i 


204  PUBLIC  PKOTECTIOlsr   OF  MATEEFITY  AND  INFAlsrCY. 

Mr.  Denison.  Have  you  a  copy  of  the  resolution  of  the  National  Association  of 
State  Health  OflBcers  that  you  can  introduce  in  evidence? 

Dr.  Williams.  No;  I  have  not. 

Mr.  Denison.  Were  you  present  at  the  time  this  matter  came  before  the  association? 

Dr.  Williams.  At  a  meeting  of  our  executive  committee;  I  was  present  at  one  of 
the  meetings. 

Mr.  Denison.  How  many  were  there  on  the  committee? 

Dr.  Williams.  Ten  or  eleven. 

Mr.  Denison.  Were  10  present? 

Dr.  Williams.  I  do  not  remember  just  how  many,  but  a  quorum  was  present.  We 
rarely  have  11  persent,  but  usually  8  were  present. 

Mr.  Denison.  You  have  no  copy  of  any  resolution  that  was  passed  at  the  time  with 
reference  to  this  bill  which  can  be  introduced  in  evidence? 

Dr.  Williams.  No;  I  have  not. 

_  Mr.  Denison.  In  the  discussion  which  you  say  resulted  in  the  indorsement  of  this 
bill  did  the  association  decide  or  was  it  discussed  as  to  whether  the  administartion  of 
this  bill  ought  to  be  in  the  United  States  Public  Health  Service  or  the  Children's 
Bureau;  was  that  question  discussed? 

Dr.  Williams.  No;  I  do  not  think  that  particular  question  was  brought  up.  There 
was  a  general  approval  of  the  bill.  There  was  a  request  for  one  amendment,  which 
I  think  was  put  in  later.  The  original  bill  first  brought  before  us  last  fall  provided 
for  a  separate  division  or  bureau  or  committee  in  each  State  to  look  after  the  work 
separate  from  the  State  health  department.  The  present  bill  is  amended  so  that  it 
can  be  put  under  the  health  department  if  they  have  a  bureau,  or,  if  they  have  no 
bureau,  the  legislature  must  decide  where  it  is  to  go. 

Mr.  Denison.  I  am  speaking  with  reference  to  who  shall  have  charge  of  it  for  the 
Federal  Government.  The  bill  now  provides  that  it  is  not  to  be  under  the  Public 
Health  Service.     Do  you  understand  that? 

Dr.  Williams.  Yes;  it  is  under  the  Children's  Bureau,  which  is  one  feature  that 
could  be  improved . 

Mr.  Denison.  Did  the  national  association  or  the  executive  committee  give  thought 
to  that  subject? 

Dr.  Williams.  I  do  not  think  that  particular  phase  was  discussed. 

Mr.  Denison.  They  approved  it  without  considering  the  question  as  to  who  should 
have  the  administration  of  it? 

Dr.  Williams,  Here  is  a  letter  to  Mrs.  Putnam  from  Dr.  Rankin,  who  was  formerly 
the  president  of  the  association,  in  which  he  says: 

"All  of  the  State  health  officers  would  prefer  that  this  bill  be  frankly  recognized 
as  a  health  measure  and  placed  under  the  United  States  PubUc  Health  Service." 

I  do  not  like  to  speak  for  all  of  the  members  of  the  committee,  but  I  know  that 
most,  if  not  all,  of  us  believe  that  all  Federal  health  activities  should  be  under  the 
United  States  Public  Health  Service. 

Mr,  Denison.  I  think  that  is  a  very  material  point  to  know. 

Dr.  Williams.  That  particular  phase  was  not  officially  acted  upon.  I  do  not  like 
to  commit  the  whole  committee. 

Mr.  Barkley.  Are  there  two  organizations  in  this  country,  the  health  officers;  that 
is,  the  State  and  Territorial  Health  Officers  and  the  State  and  Provincial  Health 
Officers? 

Dr.  Williams.  We  usually  meet  four  days.  Two  days  they  meet  without  the 
United  States  Public  Health  officers  and  two  days  the  conference  meets  with  the 
Public  Health  officers.  They  are  the  same  body  with  the  exception  that  at  two  days' 
sessions  the  Surgeon  General  presides.  It  is  the  same  personnel  composing  the  con- 
ference with  the  exception  of  the  Surgeon  General  and  his  officers. 

Mr.  Barkley.  One  is  known  as  the  State  and  Territorial  Health  Officers  and  the 
other  as  the  State  and  Provincial  Health  Officers? 

Dr.  Williams.  No;  it  is  the  conference  of  State  and  Territorial  Health  Officers  of 
North  America. 

Mr.  Barkley.  That  includes  Canada? 

Dr.  Williams.  One  of  them;  yes,  sir.  When  we  meet  with  the  Surgeon  General  the 
representatives  from  Canada  are  there  upon  invitation,  but  are  not  official  repre- 
sentatives. 

Mr.  Barkley.  So  that  when  you  are  meeting  with  the  whole  body  of  officers  of 
North  America  it  is  known  as  the  State  and  Provincial  Health  Officers? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  And  when  it  is  a  meeting  of  the  members  of  the  United  States  it  is 
known  as  the  State  and  Territotial  Health  Officers? 

Dr.  Williams.  Yes,  sir.  .  j 

Mr.  Barkley.  With  the  same  personnel? 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  205 

Dr.  Williams.  Yea,  sir;  except  the  Canadians. 

Mr.  Barki.ey.  Which  one  of  these  organizations  was  it  that  indorsed  the  Sheppard- 
Towner  bill  last  fall? 

Dr.  Williams.  The  State  and  Provincial  Health  Officers. 

Mr.  Baukley.  The  whole  of  North  America? 

Dr.  Williams.  Yes.  sir. 

Mr.  Barkley.  When  the  State  and  Territorial  Health  Officers  were  meeting  with 
the  Public  Health  Service,  did  they  take  any  action  on  this  subject? 

Dr.  Williams,  The  resolutions  tnat  I  read  were  passed  on  the  date  we  met  with 
the  Surgeon  General. 

Mr.  Barkley.  The  resolutions  were  adopted  by  the  part  of  the  convention  that 
was  devoted  to  the  United  States  alone? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  The  whole  body,  composed  of  delegates  from  all  the  United  States, 
passed  the  resolution  indorsing  the  Sheppard-Towner  bill? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  If  the  bill  should  be  amended  after  the  suggestions  made  by  your 
organization,  no  matter  which  one  of  these  bureaus  in  Washington  has  the  adminis- 
tration of  the  law,  out  in  the  States  it  will  be  actually  administered  by  the  boards 
of  health? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  Provided  they  put  up  their  part  of  the  money? 

Dr.  Williams.  Yes,  sir. 

Mr.  Barkley.  So  far  as  the  State  organization  is  concerned,  there  will  not  be  very 
much  actual  difference  in  the  administration  of  the  law? 

Dr.  Williams.  We  think  it  is  better  to  have  one  central  health  authority  than  to 
have  several. 

Mr.  Barkley.  Has  Virginia  a  department  of  health  devoted  to  this  work? 

Dr.  Williams.  Yes,  sir;  we  have  a  child's  welfare  bureau. 

Mr.  Barkley.  Already  organized? 

Dr.  Williams.  Yes,  sir.  In  fact,  in  one  of  the  counties  maternity  work  is  being 
conducted. 

Mr.  Barkley.  Is  it  not  true  that  the  general  principles  of  child  hygiene  and  ma- 
ternity care  are  well  known  and  pretty  well  standardized  already  all  over  the  country, 
subject  to  differences  that  may  exist? 

Dr.  Williams.  There  is  a  great  deal  of  work  done  which  is  fairly  well  standardized. 

Mr.  Barkley.  The  differences  in  conditions  that  might  exist  in  various  States  are 
not  so  wide  that  it  would  be  impossible  to  lay  down  broad  principles  as  a  standard  for 
all  the  States? 

Dr.  Williams.  I  think  if  you  want  to  save  mothers  and  infants  that  the  work  which 
you  would  have  to  do  in  different  communities  would  vary  very  greatly.  In  some 
communities  before  you  do  the  work  that  is  usually  done  in  child  and  maternity 
welfare,  you  should  see  that  the  general  conditions,  such  as  the  proper  disposal  of 
human  filth  is  taken  care  of,  malaria  should  be  gotten  rid  of,  and  the  water  supply  to 
different  homes  should  be  properly  protected.  Those  things  should  be  done  first 
before  you  are  ready  to  put  in  your  more  highly  specialized  people  on  the  infant  and 
maternity  welfare  work. 

Mr.  Barkley.  These  regulations  from  time  to  time  from  Washington  must  be  broad 
enough  and  general  enough  and  elastic  enough  to  apply  to  any  particular  community? 

Dr.  Williams.  Yes,  sir;  exactly.  In  a  community  heavily  infected  with  malaria 
we  could  save  more  lives  by  looking  after  that. 

Mr.  Barkley.  No  bureau  in  Washington  would  be  supposed  to  lay  down  hard  and 
f^st  rules  that  could  not  be  deviated  from  by  any  community,  no  matter  what  the 
local  conditions  might  be? 

Dr.  Williams.  Well,  according  to  this  biU  I  understand  it  would  rather  narrow  the 
use  of  this  fund.  '  I  think  it  should  be  sufficiently  elastic. 

Mr.  Barkley.  If  you  proposed  to  carry  on  this  work,  in  order  that  you  might  share 
in  the  fund  created  by  this  bill,  you  would  not  expect  the  Federal  Government  to 
permit  you  to  share  in  this  money  without  having  some  overseeing  power  as  to  the 
manner  of  the  expenditure? 

Dr.  Williams.  I  think  the  Federal  Government,  putting  up  that  money,  should 
have  certain  supervisory  power. 

Mr.  Barkley.  It  must  have  a  string  on  some  of  it? 

Dr.  Williams.  Y'es,  sir. 

Mr.  Barkley.  That  is  all. 

Mr.  Ha  WES.  I  am  interested  in  the  matter  of  these  resolutions  by  the  National 
Association  of  Health  Officers.    As  I  understand,  the  matter  of  control  of  this  work  was 


206  PUBLIC  PROTECTIOlsr   OF  MATERNITY  AND  INFANCY. 

not  discussed;  that  is,  whether  it  should  be  under  the  Department  of  Labor  or  the 
Public  Health  Service? 

Dr.  WiLMAMS.  It  was  probably  discussed  but  a  vote  was  not  taken  on  details.  The 
bill  was  approved  as  a  whole. 

Mr.  Ha  WES.  Is  there  doubt  in  your  mind  that  if  the  question  had  been  discussed 
as  to  who  should  control  medical  men  or  laymen  that  the  decision  would  have  been 
in  favor  of  the  medical  men? 

Dr.  Williams.  That  is,  put  under  the  Public  Health  Service  or  the  Children's 
Bureau? 

Mr.  Ha  WES.  Yes.  ' 

Dr.  Williams.  I  really  believe  that  they  would  have  voted  unanimously  in  favor 
of  putting  it  under  the  Public  Health  Service. 

Mr.  Ha  WES.  Then,  the  resolution  passed  by  your  organization  specifically  does  say 
that  there  ought  to  be  a  central  power,  a  central  medical  body,  under  which  all  of  this 
welfare  work  should  be  centered? 

Dr.  Williams.  Yes,  sir;  that  there  should  be  a  central  Federal  department  in  charge 
of  all  health  activities. 

Mr.  Hawes.  We  have  heard  discussions  as  to  the  different  elements  entering  into 
this  question  of  social,  economic,  and  medicinal.  It  has  been  generally  conceded 
that  95  per  cent  of  the  health  conditions  of  the  mother  and  child  must  rest  on  medical 
care.  That  being  so,  if  this  department  is  to  remain  under  the  Children's  Bureau,  do 
you  not  think  it  is  wise  that  the  law  should  distinctly  define  the  power  of  the  bureau 
and  eliminate  from  such  power  all  medical  assistance,  confining  it  to  social  and  eco- 
nomic matters. 

Dr.  Williams.  I  do  not  think  that  you  should  eliminate  all  medical  assistance.  I 
do  not  know  whether  I  catch  your  question. 

Mr.  Hawes.  This  work  is  not  medical,  but  sociological? 

Dr.  Williams.  It  should  be  professional. 

Mr.  Hawes.  If  it  is  to  continue  under  the  Children's  Bureau,  should  not  the  work 
of  the  Children's  Bureau  be  clearly  defined  in  the  law  as  to  how  far  they  should  go, 
should  it  be  limited  to  the  sociological  and  economic  elements? 

Dr.  Williams.  You  should  see  that  the  Children's  Bureau  has  the  proper  medical 
supervision;  it  should  have  trained  professional  people  who  know  what  is  best  for  the 
infants  and  mothers.  I  do  not  think  that  you  can  carry  on  work  for  infants  and  mater- 
nity welfare  solely  by  social  workers  or  nonprofessional  people. 

Mr.  Hawes.  If  they  step  outside  of  that 

Dr.  Williams  (interposing).  I  would  mention  that  in  the  city  of  Richmond  since 
they  started  welfare  work  the  number  of  deaths  of  infants  from  diarrhea  has  been 
reduced  one-half. 

Mr.  Hawes.  Under  the  work  of  doctors? 

Dr.  Williams.  Doctors  and  trained  nurses. 

Mr.  Hawes.  Trained  nurses  acting  under  the  direction  of  doctors? 

Dr.  Williams.  Yes,  sir.  I  think  this  work  would  have  to  be  done  by  trained  people. 
A  social  worker  is  not  trained  to  know  what  is  best  for  the  infant. 

Mr.  Hawes.  There  is  a  certain  field  for  the  work  of  the  social  worker  with  mother 
and  child  in  an  educational  way  that  can  be  carried  on  by  laymen? 

Dr.  Williams.  Very  little  without  professional  care.  One  of  the  greatest  causes  of 
infant  mortality  is  the  result  of  midwives.  Those  midwives  must  be  super\'ised  if  we 
are  to  reduce  both  morbidity  and  the  death  rate.  I  should  imagine  that  under  this 
act  one  of  the  chief  features  of  the  work  would  be  the  proper  super\T.sing  and  training 
of  the  midwives.  Those  ignorant  women  are  the  cause  of  many  deaths  among  mothers 
and  infants.  That  training  requires  professional  knowledge.  Prenatal  care  to  the 
mother  must  be  given  by  someone  who  knows,  either  doctors  or  nurses. 

Mr.  Hawes.  In  your  opinion  the  directing  head  should  be  an  expert? 

Dr.  Williams.  Yes,  sir:  an  expert  in  pregnancy. 

Mr.  Rayburn.  Doctor  Williams,  do  you  think  or  not  that  the  question  of  maternity 
and  infant  care  is  a  social  or  a  medical  question? 

Dr.  Williams.  The  prevention  of  morbidity  and  mortality  among  mothers  and 
infants  is  very  largely  and  chiefly  professional.  Of  course,  it  is  economic  and  social, 
so  to  speak,  but  the  main  purpose  is  to  save  life. 

Mr.  Rayburn.  Do  you  think  that  it  would  be  more  necessary  for  an  expectant 
mother  and  when  she  does  become  a  mother  and  for  the  child  for  her  to  have  a  doctor 
than  it  would  be  to  have  instruction  from  nonmedical  sources,  even  during  all  the  time 
of  pregnancy? 

Dr.  Williams.  She  certainly  should  have  instruction  from  professional  sources, 
preferably  a  doctor,  and  if  not  a  doctor  then  a  welfare  nurse  trained  in  that  line  of 
work;  certainly  not  from  a  lay  source.  That  is  the  trouble  now,  so  much  information 
from  lay  sources — this  is  responsible  for  the  high  mortality. 


PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY.  207 

Mr.  Rayburn.  There  are  105,000,000  people  that  would  like  to  see  all  the  infanta 
and  mothers  saved.  Those  of  ns  who  may  be  liold  enough  to  offer  an  amendment  to 
this  bill  or  to  ask  a  question  that  would  show  that  we  are  not  entirely  in  line  with  all 
the  principles  of  the  bill — it  is  not  because  we  are  not  in  favor  of  taking  care  of  the 
mothers  and  infants — bold  enough  to  say  that  this  is  a  medical  question  which  should 
be  under  the  Public  Health  Service,  may  be  referred  to  as  being  against  maternity 
and  child  welfare. 

Dr.  Williams.  I  think  that  is  the  reason  so  many  people  have  indorsed  this  bill, 
because  everybody  is  in  favor  of  its  purpose. 

Mr.  Rayburn.  Exactly. 

Dr.  Williams.  They  do  not  want  to  be  in  the  position  of  opposing  the  bill,  although 
they  may  object  to  many  features. 

Mr.  Rayburn.  In  other  words,  if  you  should  submit  the  proposition  to  any  conven- 
tion of  civilized  men  in  the  world  as  to  whether  or  not  they  wanted  to  save  the  lives  of 
mothers  and  infants  they  would  vote,  of  course,  to  save  them? 

Dr.  Williams.  Yes,  sir. 

Mr.  Rayburn.  Every  organization? 

Dr.  Williams.  Yes,  sir. 

Mr.  Rayburn.  You  can  not  say  that  they  must  be  saved  through  the  Children's 
Bureau  or  saved  through  the  Public  Health  Service,  but  nearly  everybody  would  say 
that  sometime,  before,  after,  and  during  the  birth,  there  ought  to  be  a  doctor  around? 

Dr.  Williams.  Yes,  sir. 

Mr.  Rayburn.  Somebody  with  skill? 

Dr.  Williams.  Yes,  sir. 

Mr.  Rayburn.  And  it  is  the  judgment  of  some  of  us,  I  know,  that  it  would  be  better 
taken  care  of  by  people  who  were  specially  trained  as  doctors  are? 

Dr.  Williams.  Yes,  sir. 

Mr.  Rayburn.  You  will  agree  with  me  further  that  there  are  very  few  communities 
in  the  United  States  in  which,  within  a  radius  of  5  to  10  miles,  there  can  not  be  found  a 
doctor  competent  to  handle  such  a  case? 

Dr.  Williams.  Yes,  sir. 

Mr.  Mapes.  Dr.  Williams,  to  what  extent  is  your  State  now  doing  the  work  con- 
templated to  be  done  by  this  bill? 

Dr.  Williams.  In  several  counties  we  are  doing  the  work  and  in  several  of  the  cities . 

Mr.  Mapes.  Through  the  public  health  service  of  the  State? 

Dr.  Williams.  It  is  entirely  done  through  official  health  organizations. 

Mr.  Mapes.  You  are  trying  to  educate  the  people  to  take  care  of  maternity  and 
infant  cases? 

Dr.  Williams.  Yes,  sir. 

Mr.  Mapes.  To  what  extent,  if  any,  is  the  Federal  Public  Health  Service  assisting 
you  in  that  work? 

Dr.  Williams.  We  have  just  across  the  river  from  here,  in  Arlington  County,  a  health 
unit  in  which  the  Public  Health  Service  is  helping  and  to  some  extent  in  the  general 
health  work,  of  which  infant  and  maternity  work  is  a  part,  a  part  of  the  regular  health 
department  work. 

Mr.  Mapes.  To  some  extent,  but  to  just  what  extent? 

Dr.  Williams.  I  can  not  speak  as  to  that.  One  nurse  devotes  her  whole  time  to  the 
work  and  there  is  an  infant  clinic.     Dr.  Cox,  who  is  here,  is  the  health  officer. 

Mr.  Mapes.  Is  that  a  United  States  nurse? 

Dr.  Williams.  Some  of  the  fund  for  this  nurse  comes  from  the  Federal  service. 

Mr.  Mapes.  Are  you  familiar  with  the  act  creating  the  Federal  Public  Health 
Service? 

Dr.  Williams.  I  have  read  it,  but  I  can  not  say  that  I  could  pass  an  examination 
on  it. 

Mr.  Mapes.  Can  you  state  where  the  Public  Health  Service  gets  authority  to  do 
this  work? 

Dr.  Williams.  Under  its  authority  to  make  demonstrations  and  investigations  in 
rural  health  matters. 

Mr.  Mapes.  Particularly  sanitation  and  sewage? 

Dr.  W'lLLiAMs.  And  general  health  Avork  also,  and  I  cordially  in\'ite  the  members  of 
this  committee  to  go  across  the  river  to  Arlington  to  see  this  work.  We  have  the  health 
department  in  active  operation  %Tith  its  health  center,  and  so  on,  and  I  am  sure  you 
would  be  very  much  interested-  to  see  this  work  in  actual  operation. 

Mr.  Mapes.  If  there  is  any  Federal  statute  which  authorizes  the  Public  Health 
Service  to  do  that  work,  I  would  be  glad  to  have  it  pointed  out  to  me. 

Dr.  Williams.  It  is  under  demonstrations.  You  will  see  that  there  is  a  certain 
appropriation  which  is  given  to  the  various  States  for  demonstration  work. 


208  PUBLIC  PROTECTIOIsr   OF  MATERNITY  AND  INFANCY. 

Mr.  Mapes.  All  I  can  find  along  that  line  is  this:  "The  Public  Health  Service  may 
study  and  investigate  the  diseases  of  man  and  conditions  influencing  the  propagation 
and  spread  thereof,  including  sanitation  and  sewage,  and  the  pollution,  either  directly 
or  indirectly,  of  the  navigable  streams  and  lakes  of  the  United  States,  and  may  from 
time  to  time  issue  information  in  the  form  of  publications  for  the  use  of  the  pubUc. 

The  Chairman.  What  is  that  act? 

Mr.  Mapes.  That  is  the  act  creating  the  Public  Health  Service. 

The  Chairman.  Look  under  the  act  of  1912  and  see  what  you  find  there. 

Mr.  Mapes.  This  is  the  act  of  August  14,  1912. 

Dr.  Williams.  There  is  a  special  appropriation  made  in  the  sundry  civil  bill  for 
demonstration  work. 

Mr.  Mapes.  Has  any  subsequent  law  broadened  the  powers  and  functions  of  the 
Public  Health  Service? 

Dr.  Williams.  I  really  could  not  tell  you,  but  I  imagine  that  if  the  sundry  civil  bill 
carried  an  appropriation  for  a  specific  purpose  it  could  be  carried  out. 

Mr.  Mapes.  Unless  there  is  some  legislation  on  the  appropriation  bill,  it  must  be 
limited  to  the  purposes  defined  in  the  act  creating  the  service. 

Dr.  Williams.  I  think,  perhaps,  we  should  have  one  of  the  public  health  men  tell 
you  about  that. 

Mr.  Barkley.  Doctor,  there  has  been  a  good  deal  said  here  on  both  sides  of  this 
question  about  the  medical  and  the  sociological  and  the  economic  phases  of  this  work. 
I  am  frank  to  say  I  have  not  any  very  clear  idea  as  to  what  the  medical  profession 
regards  as  strictly  medical  and  what  it  regards  as  physiology  in  the  treatment  of  the 
human  being.  Could  you  just  briefly  draw  the  line  between  things  that  the  medical 
profession  regard  as  strictly  medical  and  those  that  are  not  medical  but  pertain  to  the 
health  and  welfare  of  the  people. 

Dr.  Williams.  I  suppose  you  refer  particularly  to  this  maternity  feature.  Labor  is 
considered  a  physiological  process,  but  about  5  per  cent  of  labors  are  pathological; 
that  is,  they  are  not  normal,  they  are  abnormal. 

Mr.  Barkley.  I  do  not  mean  to  limit  it  to  the  actual  labor,  but  I  mean  all  that  goes 
before,  leading  up  to  birth  and  then  afterwards;  the  part  that  is  looked  upon  as  medical 
and  that  which  is  looked  upon  as  either  a  combination  of  social  or  physiological  con- 
ditions that  may  bring  about  a  happy  termination  of  the  event,  without  the  adminis- 
tering of  any  medicine  or  any  medical  attention. 

Dr.  Williams.  Although  labor  is  a  normal  process,  yet  it  is  a  dangerous  process 
because  accidents  are  so  liable  to  occur.  Every  woman  when  she  becomes  with  child 
should  have  the  attention  of  a  doctor,  and  she  should  have  examination  to  determine 
whether  her  kidneys  and  whether  her  heart  are  in  proper  condition,  or  whether  she 
has  any  lung  trouble,  because  if  she  has  any  of  those  conditions  serious  consequences 
may  follow.  So  that  when  a  doctor  is  called  upon  to  see  such  a  case  he  makes  such 
examination.  In  most  of  the  cases  things  are  normal,  but  if  the  expectant  mother  has 
a  bad  case  of  tuberculosis  it  may  be  advisable  that  they  terminate  the  labor.  Some- 
times they  find  that  the  kidneys  are  diseased,  in  which  instance  it  takes  the  skill 
of  a  doctor  to  determine  whether  to  continue  or  not. 

Mr.  Barkley.  Those  are  all  medical  questions. 

Dr.  Williams.  Yes;  those  are  medical  questions,  and  therefore  if  a  social  worker 
who  was  not  fully  acquainted  with  those  things  should  see  such  a  person,  they  could 
not  determine  about  such  matters  and  they  might  go  along  until  serious  consequences 
would  follow. 

Mr.  Barkley.  I  do  not  understand  that  under  this  bill  either  the  Public  Health 
Service  or  the  Children's  Bureau  would  administer  actual  physical  treatment  in 
cases  of  that  sort,  but  this  work,  as  I  understand  it,  is  to  be  educational,  and  not  to 
treat  kidney  trouble  or  heart  trouble,  or  any  other  specific  ailment,  but  to  try  to  bring 
about  a  betterment  of  general  conditions  in  the  communities  where  these  mothers 
and  expectant  mothers  live,  because  when  the  time  comes  for  the  actual  and  neces- 
sary medical  treatment  somebody  is  going  to  get  a  doctor,  and  that  will  happen  no 
matter  who  has  charge  of  this  particular  work. 

Dr.  Williams.  Of  course,  the  person  must  see  that  every  mother  is  given  advice 
to  see  a  doctor,  and  to  see  that  they  are  not  the  victims  of  some  ignorant  midwife. 

Mr.  Barkley.  I  realize  that  to  pursue  this  question  would  take  up  all  the  morning, 
so  that  I  shall  not  take  up  any  more  of  your  time. 

Mr.  HocH.  Doctor,  could  you  tell  us  a  little  more  definitely  just  what  sort  of  work 
is  done  in  the  counties  of  Virginia,  of  which  you  speak,  in  the  matter  of  maternity   . 
care? 

Dr.  Williams.  The  mothers  are  visited  by  the  trained  nurse. 

Mr.  HocH.  Just  a  moment.  Let  me  ask  you  there.  You  say  the  mothers  are  visited ; 
you  mean  upon  request  or  does  the  nurse  go  out  and  locate  the  prospective  mother? 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  209 

Dr.  Williams.  Of  course,  those  that  are  well  to  do  do  not  need  the  visit  of  a  nuree, 
because  they  will  have  a  doctor,  hut  there  are  always  a  lot  of  people  who  are  glad  to 
have  a  visit  from  the  nurse  to  advise  them,  and  it  soon  becomes  noised  around  in  the 
community  that  there  is  a  Public  Health  nurse,  and  the  mothers  are  glad  to  avail 
themselves  of  her  services.  They  do  not  have  any  trouble  in  finding  plenty  of  work 
to  do  in  advising  the  mothers  as  to  the  care  of  themselves  and  in  getting  ready  for  the 
infant. 

Mr.  HocH.  This  public  health  nurse  simply  establishes  her  headquarters  at  some 
))lace  in  the  county,  and  then  she  depends  upon  invitations  from  prospective  mothers 
who  want  her  services? 

Dr.  Williams.  Yes,  sir;  and  many  doctors  will  notify  them  to  visit  so  and  so. 

Mr.  HooH.  Did  I  understand  you  to  say  that  these  public-health  nurses  or  county 
health  nurses  are  paid  for  partly  by  the  Federal  Government? 

Dr.  WiLLiAM.s.   Under  this  demonstration  work  over  in  Arlington. 

Mr.  HocH.  Just  in  that  one  county? 

Dr.  Williams.  That  is  the  only  county  in  Virginia  at  the  present  time  where  there 
is  maternity  and  infant  welfare  work  conducted  in  cooperation  with  the  United 
States  Public  Health  Service.  We  have  some  other  counties  in  which  soil-pollution 
work  is  being  carried  on  jointly  with  the  Public  Health  Service. 

The  Chairman.  Mrs.  Lockwood,  will  you  kindly  make  such  statement  as  you 
desire? 

STATEMENT  OF  MRS.  HENRY  LOCKWOOD,  CLARENDON,  VA. 

The  Chairman.  Give  your  name,  address,  and  any  representation  which  you  wish 
to  make. 

Mrs.  Lockwood.  Mrs.  Henry  Lockwood,  Clarendon,  Va. ;  president  of  the  Virginia 
Federation  of  Women's  Clul)s;  president  of  the  Arlington  County  Women's  Club; 
member  of  the  committee  of  twenty-six  on  rural  life,  appointed  by  the  governor  of 
Virginia,  and  of  which  Hon.  R.  Walton  Moore  is  chairman;  and  then  I  have  some  other 
work  that  1  do  which  I  do  not  think  need  come  under  this  head. 

I  want, to  say  that  any  member  of  this  committee  who  is  bold  enough  to  indorse 
this  work  and  yet  amend  this  bill  to  put  it  under  trained  doctors  and  nurses  will  not 
weaken  his  position  with  the  women  of  the  organizations  of  which  I  have  been  a  ri' em- 
ber for  the  last  10  years,  but  will  strengthen  his  position.  This  bill,  in  my  opinion, 
a.nd  from  my  experience,  has  been  indorsed  because  of  the  wonderful  work  it  will 
<lo  in  the  future  for  mothers  and  children.  I  know  that  very  few  women  understand 
organization,  and  fewer  women  understand  politics,  especially  at  this  early  stage  of 
their  being  citizens. 


as 

— which  was  the  old  name  of  the  county — the  Alexandria  County  and  Fairfax  County 
Equal  Suffrage  League,  every  member.  All  the  antisuffragists  that  I  knew  were 
invited  to  join  that  club,  and  a  great  many  joined  because  its  standard  was  nonpoliti- 
cal.  It  also  has  every  member  of  what  we  call  the  Mothers'  Club.  The  Mothers' 
€lub  took  the  stand  that  the  leading  church,  the  Episcopal  Church,  needed  a  parish 
hall,  and  in  that  i)arish  hall  should  be  a  social  center.  The  governors  of  the  church 
decided  they  did  not  need  a  parish  hall  and  that  if  the  Episcopal  Church  had  a 
parish  hall  it  should  do  merely  church  work.  This  band  of  12  women,  and  most  of 
them  were  uneducated  women,  although  the  leader  was  not,  but  very  good  workers, 
bought  ground  beside  the  church  and  built  the  parish  hall  and  a  month  ago  they  turned 
it  over  to  the  church  absolutely  free  of  debt,  but  with  a  provision  that  it  should  be  a 
social  center.  Last  week  the  club  met  with  me  at  its  monthly  meeting.  The  home 
of  the  president  is  the  home  of  the  club.  I  took  this  bill  and  had  the  secretary  read  it. 
It  was  read  very  carefully,  and  every  section  was  discussed  as  it  Avas  read.  Afterwards 
they  said,  "Mrs.  Lockwood,  this  is  very  fine  work,  l)ut,  oh,  what  an  awful  organization. 
Where  is  our  State  board  of  health?"*  And  questions  came  furiously  along  that  line. 
So,  on  that  test,  I  felt  very  much  reinforr-ed  on  the  stand  I  am  taking. 

In  Arlington  County  we  have  a  child-hygiene  department. 

Mr.  Johnson.  Mrs.  Lockwood,  had  you  rather  we  waited  until  you  conclude  your 
remarks  before  we  ask  you  any  questions? 

Mrs.  Lockwood.  I  would  rather  you  would,  ])ecause  I  had  really  intended  to  read 
everything  I  wanted  to  say,  because  I  thought  I  would  consume  less  time. 

Mr.  Johnson.  There  is  just  one  question  I  wanted  to  ask  you,  and  that  is,  what 
Relation  did  the  church  sustain  toward  your  organization? 

74654— 21— —14 


210  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Mrs.  LocKWOOD.  The  full  membership  is  in  this  women's  club.  I  really  cited  that 
because  I  want  you  to  see  that  the  women's  club  in  Arlington  County  is  composed  of 
very  progressive  women.     They  are  experienced  women. 

Mi.  Johnson.  What  part  does  the  church  play  in  it? 

Mrs.  LocKwooD.  The  organization  played  such  a  wonderful  part  in  the  church  that 
they  built  a  parish  hall,  and  they  made  it  a  social  center. 

Mr.  Johnson.  The  same  women? 

Mrs.  LocKWOOD.  Yes;  the  same  women. 

Mr.  Johnson.  So  you  are  not  speaking  for  any  church? 

Mrs.  LocKWOOD.  Absolutely  not.  I  am  speaking  from  the  point  of  view  of  the 
women's  club. 

Mr.  Johnson.  That  is  what  I  wanted  to  know. 

Mrs.  LocKwooD.  I  am  going  to  leave  the  child-hygiene  work  after  I  read  to  you 
my  objection  to  the  organization  in  this  bill.  It  has  been  interesting  to  sit  in  this 
audience  chamber  and  hear  the  different  viewpoints  that  could  be  written  into  the 
organization  built  into  this  bill  to  carry  out  a  Federal  plan  for  prenatal  care  of  the 
child. 

I  present  for  your  consideration  a  suggestion  that  an  organization  that  so  easily 
permits  the  fears  and  imaginations  of  its  opponents  to  influence  its  plan  of  action 
would  seem  to  be  an  unsafe  method  by  which  to  establish  this  work.  Would  it  not 
be  in  more  accord  with  the  spirit  and  purpose  of  the  Constitution  of  the  United  States 
to  have  this  work  tried  out  in  the  States  by  the  State  and  county  boards  of  health,, 
with  the  cooperation  of  the  United  States  Public  Health  Service?  At  this  time  it  is 
natural  to  use  what  we  already  have  instituted,  with  the  care,  education,  and  support 
of  the  population  of  several  decades  past  deferred  because  there  is  not  enough  money 
to  do  this  for  our  soldiers.  Is  it  reasonable  to  turn  from  this  obligation  to  build  a 
new,  expensive  organization  to  wait  the  birth  of  a  population  not  yet  existing?  This 
is  not  to  say  that  we  should  be  careless  in  giving  aid  and  information  to  the  expectant 
mother  and  her  child.  The  United  States  Public  Health  Service,  its  institution,  for 
which  we  have  paid,  its  sanitary  work,  whose  benefits  we  are  now  receiving,  its  trained 
personnel  eager  for  the  responsibilities  of  its  high  calling — I  would  rather  say  possi- 
bilities— is  the  ideal  and  logical  Federal  department  from  which  this  work  should  be 
directed. 

I  now  want  to  speak  of  the  work  in  Arlington  County  as  president  of  the  club.  At 
the  request  of  the  leading  physicians  of  the  county,  in  conjunction  with  the  State 
board  of  health  and  the  county  board  of  supervisors.  Dr.  Cox,  of  the  United  States 
Public  Health  Service,  was  detailed  to  Arlington  County  to  direct  a  rural  sanitation 
system,  to  save  the  community  from  an  epidemic  of  typhoid  and  flu.  This  was 
about  a  year  and  a  half  ago.  In  that  time,  through  Dr.  Cox's  effort  and  the  coopera- 
tion of  the  United  States  Public  Health  Service,  Arlington  County  has  a  health  pro- 
gram which  includes  rural  sanitation  system,  school  cUnic,  visiting  public  health 
nurse,  dental  clinic,  and  a  child  hygiene  clinic.  Funds  for  this  work  were  subscribed,. 
I  beileve,  from  three  sounces  and  about  $43,000  expended.  The  funds  for  the  child 
hygiene  were  as  follows:  $3,000  by  request  of  the  women's  club  was  put  in  the  year's 
health  project  by  the  board  of  supervisors;  $2,000  by  the  United  States  Public  Health 
Service  for  its  demonstration  work.  A  building  has  been  leased,  put  in  good  order, 
and  the  clinics  will  be  held  twice  a  week,  starting  about  the  1st  of  August.  Mrs. 
Readisill,  the  visiting  nurse,  will  examine  the  babies  and  advise  the  mothers.  The 
United  States  Public  Health  Service  will  lend  us  a  doctor,  well  trained  in  this  work, 
until  we  are  well  organized  and  can  handle  the  work. 

The  women's  club  is  just  a  mother  to  the  child  hygiene  department,  and  stands 
re'ady  Ho  uhdertake  work  that  may  be  of  a  social-service  nature.  The  building  con- 
tains a  health  exhibit,  a  diet  kitchin,  a  baby  department,  a  consulting  room,  and  a 
mater  iiity  room,  where  mothers  can  apply  for  attention  and  information  during  the 
last  three  months  of  pregnancy. 

The  health  department  has  brought  to  the  county  not  only  a  model  health  program, 
but  has  given  us  better  local  government,  as  the  county  health  officer  is  invited  by  the- 
citizen's  association  to  help  in  many  matters  of  civic  betterment. 

The  Chairman.  Is  that  all,  Mrs.  Lockwood? 

Mrs.  LocKWOOD.  At  present  that  is  all  I  have  to  give  in  this  concrete  form. 

The  Chairman.  Would  your  organization  or  the  officials  of  the  State,  so  far  as  you 
know,  feel  that  they  would  need  United  States  appropriations  in  order  to  see  that  this- 
work  is  developed  and  carried  on. 

Mrs.  Lockwood.  I  think — I  know  the  State  board  of  health  and  the  board  of  super- 
visors— there  were  three  sources,  and  I  can  not  think  of  the  third  source  just  now,, 
but  I  think  it  came  from  some  large  national  social  service  organization — but  I  think 
the  State  is  in  a  position  to  finance  this  work  and  do  this  work  for  itself.     I  know  that 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  211 

this  year's  health  budget  wan  assumed  entirely  by  the  courty  government,  and  we  have 
a  total  thiH  year  of  $24,000  for  heatlh  work,  and  that  money  has  been  State  money 
and  county  money. 

The  Chairman.  Is  the  State  appropriation  for  this  purpose  increasing  from  year  to 
year? 

Mrs.  Lock  WOOD.  This  plan,  so  far  as  I  know,  is  by  the  year. 

The  Chairman.  But  is  the  State  legislature  appropriating  more  and  more  money 
for  this  purpose  as  time  goes  along? 

Mrs.  LocKwooD    I  will  ask  Dr.  Cox  about  that. 

Col.  KiELEY.  Mr.  Chairman,  I  think,  perhaps,  I  can  answer  that  question  better 
than  Dr.  Cox.  We  started  cooperative  health  work  as  a  result  of  the  extra  session  of 
the  legislature  called  to  consider  good  roads.  We  got  a  little  larger  appropriation 
last  year  from  the  legislature  at  its  regular  session,  and  we  expect  a  still  larger  one,  a 
very  much  larger  appropriation,  next  year,  but  there  is  no  continuing  program.  In 
other  words,  there  was  no  bill  passed  making  an  appropriation  this  year  to  continue 
for  the  succeeding  year,  but  we  are  satisfied  we  will  get  next  year  at  least  twice  what 
we  have  now. 

The  Chairman.  Mrs.  Lockwood,  elaborating  a  little  on  Col.  Kieley 's  idea,  would  you 
feel  that  probably  the  increased  appropriation  which  the  colonel  thinks  will  come 
about  will  be  due  to  the  growing  interest  of  the  people  of  Virginia  in  this  health  work? 

Mrs.  LocKWOOu.  I  think  it  is  because  of  the  enfranchising  of  the  women.  I  do 
think  that  it  is  the  woman's  viewpoint  that  good  health  and  care  of  babies  and  some 
attention  and  some  dignifying  of  the  condition  of  the  mother  that  has  brought  all  this 
work,  in  all  its  relationships,  to  the  attention  of  the  legislature,  and  I  have  come  in 
very  intimate  contact  with  the  progressive  women  of  Virginia.  At  the  State  conven- 
tion in  Newport  News  in  May  there  were  83  local  presidents  on  the  platform,  and  I 
wish  you  could  have  heard  the  health  program  that  the  Federation  of  Clubs  has  carried 
out  in  the  State  of  Virginia.  I  know  one  club  that  absolutely  built  a  hospital  and 
another  club  subscribed  §10,000,  which  they  got  out  of  their  membership,  to  health 
work,  and  although  Vii'ginia  is  called  the  most  Qonservative  State  in  the  Union,  and  I 
always  hear  that,  and  no  matter  what  convention  I  attend,  I  always  get  that  title,  the 
health  work  that  the  women  in  Virginia  are  doing  is  really  marvelous,  and  I  really  do 
not  believe  that  we  want  or  that  we  should  put  our  hands  into  the  United  States 
Treasury,  at  its  present  low  ebb,  for  work  that  the  State  is  interested  in,  and  that  the 
State  is  perfectly  capable  of  financing. 

Mr.  Rayburn.  The  doctor  who  preceded  you  remarked  about  some  Federal  health 
work  over  here  in  Alexandria  County,  or  whatever  they  call  it. 

Mrs.  LocKwooD.  It  is  Arlington  County  now. 

Mr.  Rayburn.  Does  that  come  out  of  the  demonstration  fund  or  is  it  a  fund  that  is 
generally  distributed  among  the  counties  that  apply  with  some  requirements? 

Mrs.  LocKwooD.  The  $2,000  from  the  demonstration  fund  and  the  $3,000  for  that 
work,  as  I  said,  was  given  to  the  health  department,  not  to  the  women's  club,  at  the 
request  of  the  women's  club,  for  this  work,  and  this  §43,000  that  was  given  for  general 
health  work  was  the  means  of  our  getting  this  $23,000  from  the  county  government, 
because  they  saw  such  splendid  results  in  the  county  from  this  general  health  plan, 
and  the  county  was  perfectly  willing  to  do  that.  I  was  present  to  ask  for  this  money 
when  all  the  citizens'  associations  met  at  a  night  meeting  with  the  board  of  supervisors, 
when  they  went  over  just  the  question  of  just  how  much  the  people  could  be  taxed 
and  how  much  the  people  were  willing  to  be  taxed  for  the  county  work,  and  they  were 
perfectly  willing  to  be  taxed  for  good  work,  and,  as  a  result  of  that,  we  had  $23,000 
from  the  county  government  this  year  for  our  permanent  work. 

Mr.  Rayburn.  How  many  counties  in  Virginia? 

Mrs.  Lock  wood.  There  are  100  counties. 

Mr.  Rayburn  (continuing).  Are  organized  to  do  any  of  this  work? 

Mrs.  Lockwood.  You  will  have  to  get  that  information  from  the  State  board  of 
health. 

Col.  Kieley.  We  have  5  counties  organized  for  full  health  work  under  cooperative 
measures,  and  73,  I  believe.  Dr.  Williams,  run  their  health  work  entirely  by  them- 
selves. 

Dr.  Williams.  There  are  48  counties  that  have  public  health  nurses;  there  are  5 
counties  that  have  nurses  and  sanitary  officers  and  full-time  medical  health  officers, 
and  12  counties  that  have  sanitary  officers. 

Mr.  Rayburn.  Do  you  mean  that  you  have  48  counties  all  told  that  are  doing  some 
part  of  this  work? 

I  Dr.  Williams.  Forty-eight  counties  with  public  health  nurses  doing  some  infant 
and  maternity  work,  and  practically  all  the  cities  have  nurses. 

Mrs.  Lockwood.  I  would  like  to  tell  you,  as  a  member  of  the  rural  life  committee, 
that  the  first  plan  of  this  committee  will  be  to  get  the  universities  and  colleges  to  put 
in  a  department  that  will  train  public  health  nurses.     I  believe  one  of  them,  the  one 


212  PUBLIC  PKOTECTION   OF   MATERNITY  AND  INFANCY. 

at  Richmond,  has  that  now,  and  we  are  putting  that  in  at  the  State's  expense,  and  it 
has  the  indorsement  of  the  educational  bureau. 

Mr.  Rayburn.  You  are  very  much  interested  in  this  work,  of  course. 

Mrs.  LocKWOOD.  I  am  very  much  interested  in  this  work.  I  would  like  to  see  this 
work  go  along,  and  I  would  not  oppose  it  in  whatever  form  you  would  give  it  to  me. 

Mr.  Rayburn.  But  you  think,  however,  that  if  this  cooperation  between  the 
Federal  and  State  Governments  is  going  to  go  forward,  with  such  organizations  as 
you  have,  you  would  rather  have  it  come  through  the  Public  Hea'th  Department 
rather  than  the  Department  of  Labor?  , 

Mrs.  LocKwooD.  I  most  certainly  would  want  to  see  this  work  done  in  that  way, 
and,  of  course,  it  is  a  very  new  work,  It  is  almost  startlingly  new,  and  I  am  certain 
it  ought  to  be  in  the  hands  of  highly  trained  physicians  who  have  really  devoted 
their  lives  to  this  work.     I  think  it  would  be  very  dangerous  in  the  hands  of  laymen. 

Mr.  Rayburn.  I  presume  you  were  here  yesterday  when  some  representative  of 
the  Public  Health  Department  testified  that  they  were  doing  as  much  of  this  work 
now  as  the  Congress  would  give  them  the  money  to  do? 

Mrs.  LocKwooD.  I  am  sorry  to  say  that  I  was  not  here  yesterday. 

Mr.  Rayburn.  One  of  the  representatives  of  the  Federal  Health  Service,  I  believe 
stated  that. 

Mr.  HocH.  Mrs  Lockwood,  your  answers  to  one  of  the  questions  of  the  chairman 
puts  me  in  a  little  bit  of  doubt  as  to  your  attitude  toward  this  bill.  I  understood  you 
to  say  that  you  thought  the  State  of  Virginia  and  the  counties  of  Virginia  were  both 
able  and  prepared  to  do  this  work  satisfactorily. 

Mrs.  Lockwood.  The  State  and  county  boards  of  health  in  cooperation  with  the 
United  States  Public  Health  Service.     I  think  that  was  my  statement. 

The  Chairman  .  My  question  referred  to  financial  support. 

Mr.  HocH.  That  is  what  I  am  talking  about. 

The  Chairman.  Perhaps  Mrs.  Lockwood  does  not  understand  that  now. 

Mr.   HocH.  I  am  speaking  of  financial  support  and  whether  you  consider  that 
financial  help  from  the  United  States  (government  is  necessary  in  order  that  this  work  ( 
may  be  carried  on  in  Virginia. 

Mrs.  Lockwood.  I  think  that  eventually  the  States  would  assume  the  expense 
of  this  work,  but  I  do  think  that  if  there  is  a  Federal  agency,  that  that  Federal  agency 
should  have  money  from  the  United  States  Treasury  for  its  organization  and  for  its 
demonstration  work  and  to  pay  the  salaries  of  the  experts  that  they  might  send  to 
the  States.  I  think  the  part  they  play  should  be  financed  by  the  Federal  Govern- 
ment, but  my  contention  is  we  already  have  this  wonderful  department  of  trained 
men  who  have  already  been  financed  and  paid  for,  and  this  expense  will  not  come  to 
us  now  when  we  have  not  enough  money  to  really  educate  and  feed  the  present  popu- 
lation right. 

Mr.  HocH.  As  I  understand,  this  bill  goes  much  further  in  its  jurisdiction  than 
you  have  just  suggested,  it  also  provides  for  an  allotment  of  a  certain  sum  to  the 
States  to  be  used  by  the  States? 

Mrs.  Lockwood.  It  is  at  present  |10,000  each.  Of  course,  my  assumption  was  on 
the  fact  that  in  the  Arlington  rural  district,  with  people  of  very  ordinary  means,  we 
have  been  able  to  get  $23,000  in  onecounty;  |10,000  does  not  seem  like  an  amount  to 
be  taken  into  consideration.  I  would  not  take  money  into  consideration  at  any 
rate  in  this  question.  I  am  woman  enough  for  that.  I  would  take  the  Public  Health 
Service  without  1  cent  in  money  in  preference  to  taking  social  workers  to  do  this 
work  if  they  had  a  large  sum. 

Mr.  HocH.  Perhaps,  you  do  not  understand  the  purpose  of  my  question.  As  a 
governmental  proposition,  we  are  concerned  here  in  the  consideration  of  this  particular 
bill  as  to  whether  it  is  a  necessary  function  of  the  Federal  Government  to  appropriate 
money  directly  to  the  States  to  be  used  in  the  States  in  order  that  this  work  may  be 
done  by  the  States.  I  presume  that  Virginia  would  get  |30,000  or  $40,000  in  a  direct 
appropriation  under  the  terms  of  this  bill  for  its  work  from  the  Federal  Government, 
and  I  should  like  to  ask  you  whether  you  think  that  that  is  a  necessary  appropriation 
from  the  Federal  Government  in  order  that  Virginia  may  do  the  work? 

Mrs.  Lockwood.  If  it  is  necessary  for  Virginia  to  have  this  money,  I  think  the 
Federal  Government  should  give  Virginia  the  money.  That  will  always  be  left  in 
the  hands  of  people  who  understand  finances  better  than  I  do.  I  should  like  to  see 
this  work  done,  but  I  should  like  to  see  it  done  with  as  little  expenditure  of  money 
out  of  the  Federal  Treasury  as  possible.  In  addition  to  that,  I  should  like  to  see  the 
work  left  in  the  hands  of  medical  men. 

The  ChairmXn.  I  understood  you  to  say  that  you  would  rather  have  the  Public 
Health  Service  in  control  of  this  matter  with  just  enough  money  to  demonstrate  than 
to  have  the  Children's  Bureau  with  untold  riches  at  their  command? 
Mrs.  Lockwood.  Yes,  sir. 


4 


PUBLIC  PROTECTION   OF   MATERNITY   AND   INFANCY.  213 

The  Chairman.  The  next  step  is,  would  you  rather  forego  the  $30,000  or  $40,000 
I  that  might  come  under  this  hill  if  you  had  to  he  told  that  you  would  he  ohliged  to 
do  just  what  was  ordered  hy  the  Children's  Bureau? 

Mrs.  LocKwooij.  Would  that  necessarily  have  to  happen? 

The  Chairman.  Under  this  bill;  yes. 

Mrs.  LocKwooi).  I  f  this  were  put  under  the  United  States  Puhlic  Health  Service 

The  ('haihman  (interposinj;;).  No;  under  this  liill,  nhould  it  become  a  law,  the 
State  of  Virginia  to  get  any  money  must  get  it  solely  hy  the  approval  of  the  Children's 
Bureau,  in  accordance  with  its  view  of  what  Virginia  wants  to  do. 

Mrs.  LocKwoou.  1  object  very  much  to  that  clause  in  the  bill,  ^fr.  Chairman. 

The  Chairman.  That  is  the  ])lain  Englifh. 

Mrs.  I.ocKwooi).  I  strongly  object  to  that.  It  looks  so  near  political.  I  do  not 
think  that  politics  should  touch  this  wonderful  question. 

The  Chairman.  The  hill  says  it  shall  be  that  way,  and  no  amount  of  talk  or  con- 
versation can  make  that  language  mean  anything  else. 

Mrs.  LocKwooi).  Then,  I  would  ask  a  change  to  the  United  States  Public  Health 
Service  or  a  trained  corps  of  men. 

Mr.  HocH.  I  should  like  to  ask  my  ((uestion  in  another  way.  Will  the  State  of 
Virginia,  in  your  judgment  continue  this  excellent  work  without  any  money  payment 
from  the  Federal  Government? 

Mrs.  LocKwooD.  I  am  sure  that  they  would  if  they  had  enough  money  in  their 
treasury.  Just  as  the  United  States  now  taxes  the  people,  if  the  work  was  good,  the 
people  would  stand  taxation.  If  the  State  were  in  a  position  to  do  this  work,  to  carry 
it  on  'nathout  money  from  the  Federal  Government,  I  think  they  would  do  it,  but  if 
not  and  they  felt  that  they  needed  the  work,  I  think  they  would  be  very  glad  of  funds 
from  the  United  States  Treasury  to  help  in  the  work.  Of  course.  I  am  not  a  consti- 
tutional lawyer  and  I  do  not  know  just  how  far  the  Federal  Government  is  responsible 
for  the  financing  of  the  contem])lated  work  in  the  States.  Is  it  not  a  fact  that  generally 
money  ajipropriated  for  all  of  this  kind  of  work  in  the  different  States  is  given  to  them 
for  printing  and  for  jiamphlets  and  for  distribution? 

The  Chairman.  That  is  rather  an  involved  question  that  would  lead  to  a  good  deal 
of  talk.  I  should  like  to  ask  you  one  other  question.  If  Virginia,  through  its  own 
pride  and  interest  in  its  citizens,  is  calling  to  appropriate  money  for  carrying  on  this 
health  work,  including  the  infant  and  maternity  work,  will  Virginia  want  to  be  taxed 
for  sending  money  to  some  other  State  that  is  not  willing  to  carry  on  the  work? 

Mrs.  LocKwooD.  No. 

The  Chairman.  You  realize  that  it  would  have  to  do  that? 

Mrs.  LocKwooD.  Yes,  sir;  but  you  are  more  familiar  with  the  contents  of  this 
bill  than  most  of  the  women  who  have  indorsed  it,  because  of  its  merits.  I  was  the 
director  in  the  headquarters  of  the  General  Federation  of  Women's  Clubs  in  Wash- 
ington. We  had  there  and  have  still  a  bureau  of  information  for  the  club  women 
all  over  the  United  States.  When  a  bill  came  up  I  would  always  come  to  Congress 
and  talk  to  the  Congressman  who  had  introduced  it  and  try  to  send  back  information 
on  the  bill.  One  day  Ann  Martin,  who  ran  for  the  Senate  from  the  State  of  Nevada, 
told  me  that  there  was  a  bill  in  the  making,  called  the  Sheppard-Towner  bill,  and 
that  the  general  federation  ought  to  have  information  on  it.  I  went  to  the  Capitol 
and  got  a  copy  of  the  bill  and  took  it  back  to  my  oiTice  and  looked  into  it.  Then  I 
called  up  Senator  Sheppard's  secretary  and  asked  for  an  interview  in  order  that  I 
could  send  out  information  as  to  the  bill.  Then,  I  went  to  Senator  Sheppard's 
office  but  I  did  not  get  an  interview.  I  was  told  to  come  back.  I  went  back  two 
or  three  different  times,  but  I  still  did  not  see  him.  Then  I  went  again  and  still 
did  not  see  him.  I  did  not  know  whether  the  Senator  thought  that  he  did  not  know 
much  about  maternity  or  what  was  the  trouble.  I  gave  it  up.  WTien  I  had  indorsed 
this  bill  and  said  that  it  was  a  good  bill  I  had  no  realization  of  the  organization  that 
was  Avritten  into  the  bill.     It  seems  an  entirely  different  bill  from  what  I  looked  into. 

I  want  to  say  here  that  I  have  the  very  highest  opinion  of  Miss  Lathrop  and  her 
work.  I  know  what  I  am  talking  about  because  I  was  the  director  at  national  head- 
quarters and  I  was  in  touch  with  all  the  departments  of  work  of  the  Federal  Gov- 
ernment, and  it  was  a  revelation  to  me  what  the  Federal  Government  did  in  the 
way  of  education  for  its  people.  It  was  a  very  beautiful  revelation  to  me.  Mies 
Lathrop  was  always  very  courteous  and  generous  and  would  give  advice  and  tell 
me  what  pamphlets  to  conserve,  as  they  had  gone  out  of  issue  and  there  was  no  more 
money  for  printing  them.  I  think  if  I  had  the  drafting  of  this  bill — I  am  getting 
rather  daring — I  would  put  Miss  Lathrop  on  the  ad\'isory  committee  and  I  would 
make  the  advisory  committee  compulsory.  I  wish  that  we  could  have  two  more 
women  like  Miss  Lathrop  and  Dr.  Baker  in  every  State. 

Mr.  Johnson.  The  advisory  committee? 


214  PUBLIC  PROTECTIOlSr   OF  MATERNITY  AND  INFANCY. 

Mrs.  LocKwooD.  Yes;  the  advisory  committee.  I  believe  the  Children's  Bureau 
is  given  power  to  appoint  an  advisory  committee  with  the  Surgeon  General  and  the 
Commissioner  of  Education. 

The  Chairman.  Given  authority,  but  it  is  not  compulsory? 

Mrs.  LocKwooD.  No,  sir. 

I  have  been  amazed  for  the  last  five  years  to  see  the  Suffragists.  Of  course,  I  have 
worked  for  seven  years  and  I  was  the  treasurer  for  the  National  Women's  Organiza- 
tion for  a  year  and  a  half,  to  hear  suffragists  claim  the  population  of  the  women,  and 
also  the  antisuffragists.  I  think  if  there  is  one  thing  that  should  be  borne  in  mind  it 
is  that  I  do  not  believe  the  men  understand  the  women  just  as  well  as  they  ought  to. 
Many  of  us  worked  for  suffrage  and  many  are  antisuffrage,  and  we  asked  for  recognition 
and  for  a  voice  in  the  Government  because  we  had  work  to  do  and  we  felt  that  we  could 
do  that  work  better,  and  when  we  got  what  we  asked  for  I  went  home  and  went  to 
work.  I  am  very  sorry  to  see  a  group  of  suffragists  to-day  with  an  absolute  legislative 
program,  because  it  is  my  opinion  that  women  have  just  as  much  work  to  do  as  men 
have  and  it  is  harder  on  our  nerves.  I  am  sorry  that  the  women  have  got  to  keep 
their  eyes  on  legislation  all  the  time,  things  that  probably  the  majority  of  the  women 
of  the  country  do  not  want.  I  am  a  suffragette,  but  I  believe  that  the  antisuffragists' 
interests  must  be  taken  into  consideration,  because  the  antisuffragist  is  a  woman 
citizen.  That  is  why  when  I  got  through  with  securing  suffrage  and  went  home  I 
resigned  from  the  women's  organizations  that  I  belonged  to.  I  am  sorry  to  see  this 
purely  legislative  program,  because  it  is  going  to  overwork  the  women. 

The  Chairman.  We  will  now  hear  the  representatives  of  the  Public  Health  Service. 

Mr.  Hawes.  Before  calling  on  the  representatives  of  the  Public  Health  Service, 
may  I  be  permitted  to  place  in  the  record  a  statement  of  the  work  that  is  done  in 
Missouri,  and  then  the  examination  can  proceed  more  clearly.  This  is  from  the 
Annual  Report  of  the  Surgeon  General  of  the  Public  Health  Service,  under  date  of 
1920.     On  pages  46  to  48  I  find  the  following: 

"On  request  of  the  acting  governor  of  Missouri  and  the  State  board  of  health  an 
officer  was  assigned  to  this  State  in  October,  1919,  to  assist  in  the  organization  of  a 
division  of  child  hygiene  in  the  State  board  of  health  and  to  cooperate  with  the  State 
board  of  health  in  State-wide  field  investigations  in  child  hygiene. 

"The  scope  of  the  work  included  (1)  organizing  a  division  of  child  hygiene  in  the 
State  board  of  health;  (2)  making  field  investigations,  consisting  of  a  house-to-house 
canvass  in  selected  districts,  for  obtaining  data  as  to  sanitary  conditions  of  the  homes, 
the  family  income,  milk  supply,  the  physical  and  mental  status  of  expectant  mothers, 
and  the  health  conditions  of  infants  and  children;  (3)  studying  the  school  hygiene 
problems,  making  height  and  weight  measurements,  attempting  to  secure  the  coop- 
eration of  parents  in  the  correction  of  physical  defects  and  in  improving  the  nutrition 
of  their  children,  securing  physical  examinations  of  children  by  local  physicians  in 
order  to  enlist  their  cooperation  and  insure  permanency  of  the  work;  (4)  establishing 
at  local  expense  health  centers  for  prenatal,  infant,  and  preschool  care;  (5)  establish- 
ing the  work  on  a  permanent  basis  by  educating  communities  in  the  importance  of  the 
problem,  and  influencing  them  to  employ  one  or  more  public  health  nurses,  school 
nurses,  and  organizing  community  health  councils;  (6)  bringing  about  better  birth 
registration;  (7)  educating  the  public  by  lectures,  exhibits,  distribution  of  literature, 
and  newspaper  feature  articles;  (8)  securing  to  the  State  board  of  health  the  active 
cooperation  of  the  State  volunteer  organizations  engaged  in  child  health  work. 

"  The  personnel  engaged  in  this  work  was  under  direction  of  a  commissioned  medical 
officer  and  consisted  of  physicians,  public  health,  nurses,  school  workers,  and  field 
investigators. 

"Results. — In  20  towns  baby  health  centers  are  being  or  have  been  established  and 
equipped,  and  funds  appropriated  for  the  employment  of  one  or  more  permanent 
community  nurses.  School  medical  inspections  have  been  made  in  11  towns,  and  a 
total  of  17,561  children  were  examined,  among  whom  there  were  observed  34,823 
physical  defects,  such  as  defects  of  vision,  hearing,  and  dentition,  nasal  defects, 
enlarged  tonsils,  adenoids,  and  skin  diseases. 

"Of  16,867  children  examined  in  nine  communities,  3.7  per  cent  had  defective 
vision  in  one  eye,  1.2  per  cent  defective  vision  in  both  eyes,  2.3  per  cent  defective 
hearing  in  one  ear,  2  per  cent  defective  hearing  in  both  ears,  53.4  per  cent  had  carious 
teeth,  11.4  per  cent  adenoids,  38.2  per  cent  enlarged  tonsils,  0.4  per  cent  active  tuber- 
culosis, 1.3  per  cent  trachoma,  and  0.8  per  cent  defective  speech. 

"  In  18  towns  clinics  were  held  for  the  study  of  malnutrition.  Of  4,076  underweight 
children  who  were  examined  at  these  clinics,  26.6  per  cent  were  mouth  breathers,  38.4 
per  cent  had  defective  tonsils,  12.6  per  cent  adenoids,  54.7  per  cent  defective  teeth 
43.1  per  cent  appeared  anemic,  and  61.7  per  cent  assumed  fatigue  posture.  Further- 
more, of  these  children  17.4  per  cent  were  excessive  coffee  users,  31.2  per  cent  con, 
sumed  an  inadequate  amount  of  milk,  and  15.8  per  cent  were  excessive  meat  eaters- 


._J. 


PUBUO  PROTECTION  OF  MATERNITY  AND  INFANCY.  215 

"In  1,100  underweight  children  in  18  schools  of  8  towns  in  the  State  who  attended 
the  nutrition  clinics  for  two  or  more  months,  781,  or  71  per  cent,  gained  2  or  more 
pounds  per  montli;  in  {)2,  or  9.4  per  cent,  the  weight  remained  stationary;  and  227, 
or  20.6  per  cent,  lost  weight. 

'  'The  following  agencies  have  cooperated  in  this  work:  Missouri  Tuberculosis  Asso- 
ciation, American  Red  Cross,  Agricultural  Extension  Service  of  the  University  of 
Missouri,  Parent  Teachers'  Association,  Women's  Christian  Temperance  Union,  the 
medical  and  dental  professions,  and  in  a  number  of  districts  the  superintendents  of 
■education  and  allied  school  authorities. 

"The  investigations,  as  conducted  in  Missouri  during  the  past  year,  have  shown 
that  definite  and  permanent  results  can  be  accomplished  by  the  employment  of  proper 
methods." 

"This  work  was  done  under  the  instruction  of  the  Public  Health  Service  through  the 
•direct  instrumentality  of  the  State  health  board,  under  laws  passed  by  the  Legislature 
of  Missouri. 

The  Chairman.  At  the  expense  of  the  State  of  Missouri? 

Mr.  Hawes.  Yes,  sir.  In  addition,  I  have  a  letter  from  a  gentleman  who  speaks 
very  highly  of  this  bill  that  is  before  us,  but  makes  some  suggestions  for  changes,  a 
man  who  is  devoting  his  time  without  compensation  to  this  work.  He  is  the  president 
of  one  of  the  large  health  societies,  Dr.  M.  D.  Lightfoot.     I  offer  his  letter  for  the  record. 

The  Chairman.  Without  objection,  it  will  be  inserted  in  the  record. 

(The  letter  submitted  by  Mr.  Hawes,  addressed  to  the  chairman,  follows:) 

Hon.  Samuel  E.  Winslow, 

Chairman  Committee  on  Interstate  and  Foreign  Commerce. 

Gentlemen:  I  consider  parts  of  bill  H.  R.  2366  very  good.  I  am  very  much  in 
sympathy  with  the  work  as  contemplated.  Under  no  condition  would  I  be  willing 
to  see  the  maternity  and  infancy  work  as  contemplated  in  this  bill  fail.  However, 
the  experience  we  have  had  in  our  organization  leads  me  to  the  inevitable  conclu- 
sion that  the  administration  of  this  work  should  be  under  the  supervision  of  the 
United  States  Public  Health  Service  and  not  under  the  Department  of  Labor — first, 
because  of  the  certainty  of  a  greatly  reduced  administrative  and  field  expense  in 
both  Washington  and  the  country  at  large;  second,  because  the  United  States  Public 
Health  Service,  having  a  large  corps  of  competent  expert  health  officers,  nurses, 
and  health  workers  throughout  a  large  part  of  the  United  States,  could  carry  on  this 
work  much  more  effectively  and  with  less  delay;  third,  because  I  am  unalterably 
opposed  to  any  plan  other  than  that  of  centralizing  all  the  Federal  health  activities 
under  the  supervision  of  the  United  States  Public  Health  Service.  If  you  think  a 
Department  of  Labor  can  take  care  of  the  health  activities  of  the  Federal  Government 
better  than  the  United  States  Public  Health  Service,  then,  by  all  means,  do  away 
with  the  Public  Health  Service  and  let  the  Labor  Bureau  handle  all  the  health  prob- 
lems. Otherwise,  place  all  of  the  Federal  health  activities  under  the  supervision  of 
the  United  States  Public  Health  Service,  where  they  really  belong. 

I  am  not  impressed  with  the  argument  that  the  problems  this  bill  is  designed  to 
^correct  are  largely  social.  Our  maternity  and  infant  work  in  Greene  County  leads 
me  to  believe  that  it  is  highly  important  and  necessary  for  this  work  to  be  conducted 
by  trained  nurses  under  the  supervision  of  and  in  close  cooperation  with  skilled 
medical  advice.  Many  problems  arise  that  would  be  impossible  for  a  social  worker 
to  adequately  meet,  while,  on  the  other  hand,  we  find  that  trained  nurses  can  meet 
the  requirements  of  public  speaking,  distribution  of  literature,  and  general  social 
work,  practically  as  well  as  can  the  social  worker. 

The  Greene  County  Health  Association  was  organized  January  1,  1920.  Our  hope 
and  aim  was  prevention  rather  than  cure,  discovery,  and  removal  of  fundamental 
■disease  causes,  care  for  the  individual  when  necessary,  public  health  education,  to 
be  financed  at  public  expense,  the  Nation,  State,  and  county  cooperating.  We 
-asked  the  United  States  Public  Health  Service  to  place  us  under  the  supervision  of 
the  Tri-State  Sanitary  District  and  furnish  us  with  an  acting  assistant  surgeon.  This 
was  done,  and  the  help  from  the  United  States  Public  Health  Service  has  been  of 
very  great  benefit  to  us  in  the  local  work. 

The  Greene  County  Health  Association  plan  shows  the  feasibility  and  economy 
of  general  health  supervision.  Our  primary  trouble  was  excessive  administrative 
and  field  expense  because  of  the  widely  scattered  health  activities.  We  have  suc- 
ceeded in  coordinating  all  of  these  various  activities  and  bringing  them  under  the 
active  head  of  the  United  States  Public  Health  Service  acting  assistant  surgeon, 
with  the  result  that  93  cents  of  every  dollar  expended  goes  into  actua,!  health  work, 
while  7  cents  goes  into  administrative  and  overhead.  Our  organization  is  covering 
the  entire  county  in  rural  sanitation,  health  work  among  school  children,  preschool 
-children,  babies,  prenatal  work,  tubercidosis  work,  venereal  disease  work,  and  general 
health  education  and  publicity.     If  these  different  activities  were  under  specialized 


216  PUBLIC   PROTECTION   OF   MATEEiTITY  AFD  INPAFCY. 

departments  instead  of  under  a  general  closely  coordinated  health  plan,  we  would  be 
spending  nearer  93  cents  of  every  dollar  on  overhead  and  administrative  and  only 
7  cents  of  every  dollar  on  actual  health  work. 

I  believe  that  a  broad  general  health  program  under  Federal  supervision  is  the 
only  solution.  This  program  should  cover  a  number  of  years  to  insure  its  permanent 
success.  In  the  interest  of  economy  and  eflBciency  this  program  should  be  under  one 
general  supervision  and  carried  out  along  definite  practical  health  lines,  cooperating 
with  State,  county,  city,  and  private  health  organizations  and  yet  elastic  enough  to 
fit  the  particular  needs  of  each  community.  This  general  health  work  would  ob- 
viously include  all  necessary  specialized  health  work.  On  the  other  hand,  a  series  of 
specialized  health  activities  would  necessarily  exclude  from  its  program  all  general 
health  work. 

The  people  are  rapidly  learning  to  have  the  fullest  confidence  in  the  health  activi- 
ties of  the  United  States  Public  Health  Service  and  I  believe  the  recent  appropria- 
tion by  the  legislature  in  Missouri  for  health  work  was  influenced  largely  by  the  work 
done  in  Greene,  Jasper,  and  Lawrence  Counties  by  the  United  States  Public  Health 
Service.  The  effect  in  Greene  County,  Mo.,  has  been  marvelous.  Under  the  old 
order  the  county,  city,  and  private  health  organizations  all  functioned  without  any 
coordination  and  very  little  efficiency. 

In  the  last  year  and  a  half  under  Federal  supervision  the  acting  assistant  surgeon 
has  succeeded  in  coordinating  all  these  health  activities,  with  the  result  that  the 
county  has  made  him  county  health  commissioner,  the  city  of  Springfield  has  made 
him  assistant  city  health  commissioner,  and  he  has  supervision  of  practically  all  of 
the  private  health  organizations  of  the  community  and  in  this  manner  some  very 
efficient  and  startling  results  have  been  obtained,  as  our  detailed  report  at  the  end 
of  this  testimony  will  show. 

Another  very  striking  example  of  the  confidence  inspired  by  the  United  States 
Public  Health  Service  work  follows:  For  years  the  local  health  officers  of  the  county 
have  been  trying  to  better  the  rural  sanitation  in  the  schools,  this  without  any  success. 
Under  one  year  of  our  Federal  health  supervision  we  have  succeeded  in  getting 
definite,  permanent  sanitary  corrections  in  39  of  the  105  rural-school  districts  of  the 
county. 

I  am  conservative  when  I  state  that  for  every  dollar  the  Federal  Government  has  in- 
vested in  the  services  of  our  present  acting  assistant  surgeon  United  States  Public 
Health  Service,  becaiise  of  that  investment  there  has  been  spent  from  city,  county, 
and  private  sources,  fully  $20. 

The  effect  of  the  work  done  by  the  United  States  Public  Health  Service  in  Greene 
County  has  rapidly  spread  into  other  counties  and  into  surrounding  States  and  our 
organization  is  constantly  receiving  communications  asking  for  our  plan  of  work,  how 
we  secured  Federal  cooperation  and  just  what  steps  they  can  take  to  secure  Federal 
cooperation  with  the  view  of  organizing  permanent  and  effective  health  work  in  their 
respective  communities. 

It  has  been  very  forcefully  brought  to  our  attention  that  contagious  diseases  know 
no  State  or  county  boundary  lines  and  some  of  our  hardest  problems  have  been  those 
inherited  either  directly  or  indirectly  from  communities  and  States  over  which  we 
have  no  control.  I  believe  that  health  problems  of  this  kind  are  just  as  much  the 
problems  of  the  Federal  Government  as  are  those  problems  of  Interstate  commerce 
and  just  as  careful  provisions  should  be  made  for  handling  them.  For  this  reason  I 
believe  the  work  outlined  in  H.  R.  2366  should  be  placed  under  the  active  manage- 
ment of  the  United  States  Public  Health  Service  and  the  powers  of  the  bill  should  be 
broadened  to  permit  the  United  States  Public  Health  Service  not  only  to  perform  the 
maternity  and  infant  work  required  but  other  necessary  general  health  work  as  well. 
This  could  be  done  without  any  great  delay  and  yet  be  responsible  for  a  much  greater 
amount  of  good  being  accomplished. 

The  following  is  a  report  of  health  activities  in  Greene  County,  Mo.,  from  January 
1,  1920,  to  June  30,  1921: 

Work  with  school  children: 
Medical  examination — 

Given  medical  examinations 14,  433 

Found  defective 11,  546 

Percentage  of  children  with — 

Defective  teeth 73 

Diseased  tonsils 30.  7 

Suspected  adenoids 16.  9 

Defective  vision 13 

Defective  hearing 3 

Chronic  constitutional  diseases 7 


PUBLIC  PROTECTION   OF   MATEBNITY  AND  INFANCY.  217 

Statiptic^  in  the  past  have  proven  that  children  with  neglected  teeth,  tonsils,  and 
adenoids,  are  much  more  susceptible  to  tuberculosis  than  those  who  have  these  very 
common  defects  corrected. 

Mdlnutrilion  in  school  children. — Forty-oive  per  cent  of  all  school  children  examined 
were  7  per  cent  or  more  underweight.  Of  this  number  26.4  per  cent  were  10  per  cent 
or  more  underweight.  Improper  food,  irregular  eating,  physical  defects,  too  much 
evening  entertainments,  and  insufficient  sleep  are  the  principal  factors  causing  this 
malnutrition.  Poverty  does  not  seem  to  be  an  important  factor,  as  the  pupils  of  the 
more  prosperous  sections  of  the  city  have  a  greater  percentage  of  malnutrition  than  do 
those  of  the  poorer  sections.  likewise,  the  rural  and  smaller  towns  in  the  county 
show  percentages  just  as  high  as  that  of  Springfield.  Nutrition  clinics  have  been  es- 
tablished where  mothers  and  children  are  urged  to  attend.  The  percentage  of  mal- 
nutrition has  been  greatly  reduced  in  the  various  schools  where  the  children  were 
weighed  regularly  each  month.  In  a  certain  school  last  fall  43  per  cent  of  the  children 
were  underweight  and  when  this  school  was  weighed  this  spring  only  13  per  cent  of  the 
children  were  underweight.  In  another,  the  percentage  has  been  reduced  from  36 
per  cent  to  11 J  per  cent,  and  in  still  another  from  37  per  cent  to  14  per  cent,  and  con- 
tinued progress  is  being  made. 

Corrective  work  following  examinations: 

Defects  corrected  in  full 3,  987 

Schools  in  wh  ich  follow-up  work  has  been  started 75 

The  modern  health  crusade  has  been  established  in  each  schoolroom  in  Greene 
County.  We  find  this  program  not  only  educating  the  children  but  that  the  awakened 
child  is  educating  the  parents. 

Public  health  nursing: 

Visits  by  nurses  to  explain  infant  care 2,  457 

Visits  to  give  prenatal  and  obstetrical  care 241 

Visits  to  communicable  diseases 324 

Clinical  work: 

Babies  examined  in  clinics  by  physicians 2,  042 

School  children  and  adults  examined 717 

Treated 131 

Glasses  provided  for 22 

Cases  of  tonsils  and  adenoids  removed 98 

Dental  treatment  provided  for  (approximately) 72 

Vaccination: 

Antismallpox  vaccinations 309 

( 'omplete  antityphoid  inoculations 159 

Education: 

Talks  to  groups  of  persons 463 

Pieces  of  literature  distributed 51,  411 

People  attending  lectures 14, 156 

School  sanitation:  ^ 

Sanitary  inspections - 437 

Schools  which  have  made  definite  sanitary  improvements 39 

Venereal-disease  control: 

Patients  examined - 892 

Patients  treated 661 

Visits  for  treatment 6,  896 

Cured  cases  to  date 371 

Wassermans  and  gonorrheal  examinations 575 

Curative  treatments  for  both • 6,  896 

Men  and  women  detained  and  isolated  until  made  noninfectious 79 

It  is  impossible  to  estimate  the  value  in  dollars  and  cents  that  the  cure  of  325  cases 
of  venereal  disease  means  to  a  community.  There  are  eight  institutions  for  insane 
and  feeble-minded  people  in  Missouri  and  there  are  1,500  people  on  the  waiting  list 
to  get  into  these  overcrowded  institutions  and  4  out  of  5  patients  are  there  as  the 
result  of  venereal  diseases.  How  much  better  it  is  to  support  an  institution  which 
is  fighting  to  control  the  spread  of  these  diseases  than  it  is  to  pay  taxes  to  support 
institutions  where  these  people  live  all  their  lives  without  ever  earning  any  money  ' 
or  being  of  any  value  to  themselves  or  anyone  else. 

The  Greene  County  Health  Association  Health  Center  has  a  waiting  room  and 
private  rooms  for  operations  and  clinical  work.  The  venereal  disease  clinic  has  its 
own  waiting  room  and  spaces  for  private  treatments.  The  present  arrangement 
makes  the  Greene  County  Health  Association  quarters  the  most  up-to-date  public- 
health  department  in  the  State. 


218  PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY. 

Vital  statistics  for  Greene  County  have  in  the  past  been  very  incomplete,  but  as 
a  result  of  efforts  diu"ing  the  past  year  the  reporting  of  births  and  deaths  has  been 
much  improved,  so  that  now  it  is  practically  complete.  Morbidity  reports  were  even 
more  inaccurate.  In  order  to  increase  reporting  of  physicians,  various  checks  have 
been  made  and  the  aid  of  every  school  teacher  and  school  child  has  been  elicited  in 
reporting  absences  from  school  because  of  contagious  diseases.  Provisions  of  law 
requesting  every  school-teacher  to  report  commxmicable  diseases  have  been  given 
to  each  school-teacher  in  the  county.  At  many  lectures  in  the  county  the  parents 
have  been  urgently  requested  to  see  that  their  babies  are  registered. 

One  of  the  important  features  of  the  work  is  the  annual  baby  week.  This  year 
one  of  the  most  successful  baby  weeks  that  Springfield  has  ever  had  was  held  at  Heer's 
Department  Store  from  the  16th  until  the  21st  of  May.  The  entire  sixth  and  seventh 
floors  were  used  and  the  various  women's  clubs,  philanthropic  organizations,  and 
many  doctors  and  nurses  of  Springfield  cooperated  in  making  it  a  great  success. .  The 
following  public-health  workers  were  in  charge:  Dr.  Thomas  Parran,  Dr.  C.  P.  Knight, 
director  division  of  child  hygiene;  Dr.  Viola  Russell,  child  specialist  and  assistant 
to  Dr.  Knight;  and  Dr.  Minerva  Knott,  also  child  specialist  and  assistant  to  Dr. 
Knight;  Miss  Nellie  Heinzelman  and  Miss  Margaret  Duffey,  both  public-health 
nurses  of  the  division  of  child  hygiene.  A  large  number  of  Springfield  and  Greene 
County  mothers  took  advantage  of  this  oppertunity  to  learn  how  to  keep  their  children 
well,  and  approximately  750  babies  were  examined  dming  the  week. 

The  doctors  who  examined  the  children  durin  baby  week  noticed  a  decided  im- 
provement in  the  condition  of  the  babies  examined  over  that  of  last  year.  They 
attributed  this  to  an  increased  interest  shown  in  the  welfare  of  children  by  parents 
and  also  to  knowledge  about  the  care  of  children  which  the  mothers  had  gained  by 
attending  previous  clinics. 

In  order  that  every  baby  in  Greene  County  be  given  the  benefit  of  the  same  expert 
advice  that  children  received  at  the  Springfield  clinic,  the  Greene  County  Health 
Association  planned  14  free  health  clinics  to  be  given  throughout  the  county  for  in- 
fants and  children  of  preschool  age  who  were  ubable  to  attend  baby  week  in  Spring- 
field. These  county  traveling  baby  clinics  under  the  supervision  of  the  United  States 
Public  Health  Service  and  the  Greene  County  Health  Association  were  very  success- 
ful. A  great  dea.  of  interest  was  aroused  and  the  work  of  the  United  States  Public 
Health  Service's  specialists,  assisted  by  resident  physicians,  was  very  much  appre- 
ciated by  the  mothers  who  brought  their  babies  for  examination  and  consultation.  A 
total  of  293  babies,  450  women  and  34  men  were  present  at  the  clinics  in  the  county 
and  this,  with  the  760  babies  and  1,200  mothers  in  attendance  during  the  Springfield 
baby  clinic,  makes  this  work  the  most  complete  and  successful  that  has  ever  been 
accomplished  in  Greene  County.  The  nurses  of  the  Greene  County  Health  Associa- 
tion are  working  to  the  end  that  every  defective  child  discovered  in  the  city  as  well 
as  in  the  county,  will  be  made  normal,  as  nearly  as  possible,  and,  with  the  amount  of 
interest  that  has  been  raised  by  reason  of  the  close  cooperation  of  so,  any  of  the  United 
States  Public  Health  Service  specialists  and  nurses,  a  distinct  advance  has  been  made 
in  the  proper  care  and  treatment  of  babies  in  Springfield  and  Greene  County. 

Greene  County  has  the  distinction  of  being  the  first  and  to  date  the  only  county  in 
Missouri  to  employ  a  whole-time  health  ofiicer.  It  is  believed  that  the  results  already 
obtained  furnish  a  demonstration  of  National  and  State,  as  well  as  local,  value  as  to 
the  feasibility  and  the  doUars-and-cents  economy  of  this  plan  of  county  health  work. 
This  distinction  has  been  achieved  and  the  results  obtained — first,  by  the  whole- 
hearted cooperation  of  the  United  States  Public  Health  Service  in  furnishing  financial 
assistance  and  technical  advice;  second,  by  the  state  health  commissioner  in  giving 
full  cooperation  of  his  ofiice  and  the  assistance  of  state  health  inspectors,  nurses  and 
physicians;  third,  by  the  cotmty  court  of  Greene  County  who  has  been  so  generous 
in  assisting  both  in  financial  and  legal  support;  fourth,  last  but  not  least,  by  the  gen- 
ous  and  kind  hearted  people  of  Greene  County  who  have  opened  their  pockets  and 
said,  "  We'll  help  finance  the  movement  that  will  bring  to  Greene  County  healthy 
and  robust  boys  and  girls." 

Please  notice  that  all  of  our  different  activities,  including  the  maternity  and  baby 
work,  is  under  the  supervision  of  one  head  furnished  by  the  United  States  Public 
Health  Service. 

In  conclusion,  I  wish  to  state  that  I  have  never  received,  nor  do  I  expect  to  receive, 
one  cent  in  salary  from  the  Greene  County  Health  Association  or  from  the  United 
States  Public  Health  Service;  that  I  do  not  belong  to  the  medical  profession  in  any 
way,  but  am  simply  a  business  man  who  has  in  some  small  manner  made  a  study  of 
the  public-health  question.  I  have  been  appalled  at  the  loss  both  in  man  power  and 
in  a  financial  way  caused  by  preventable  diseases. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  219 

My  investigation  has  led  me  to  the  belief  that  a  great  percentage  of  the  children  of 
the  rural  nation  from  birth  to  majority  receive  no  medical  attention  whatever  with  the 
view  of  prevention.  It  is  my  further  belief  tliat  this  problem  will  never  be  corrected 
until  it  18  handled  by  the  Federal  Government  in  a  broad,  comprehensive,  and  effi- 
cient manner. 

Very  truly,  yours, 

M.    D.    LlOHTPOOT, 

President  Greene  County  Health  Association. 


House  op  Representatives, 
Washington,  D.  C,  July  21,  1921. 
Hon.  Harry  B.  Hawes, 

Interstate  and  Foreign  Commerce  Committee, 

House  of  Representatives. 

My  Dear  Mr.  Hawes:  In  listening  to  the  hearings  on  the  Sheppard-Towner  bill 
there  has  been  allusion  to  the  agriculture  extension  service  as  an  agency  through 
which  rural  women  and  children  might  receive  the  aid  offered  in  the  bill  now  under 
consideration. 

As  a  home  demonstration  agent  in  Lincoln  County,  Mo.,  in  the  ofhce  of  the  farm 
bureau  of  that  county,  under  the  direction  of  the  agriculture  extension  service  of  the 
University  of  Missouri,  I  have  knowledge  of  a  specific  piece  of  work  done  in  that  county 
and  am  submitting  this  information  for  your  consideration. 

^•In  1919  the  State  board  of  health  with  the  assistance  of  the  United  States  Public 
Health  Service  organized  and  promoted  three  new  bvu^eaus  in  the  State  board  of 
health:  Tuberculosis,  venereal  disease,  and  child  hygiene. 

Upon  the  invitation  of  the  home-demonstration  agent  the  State  board  of  health  sent 
a  doctor  and  a  nurse  from  the  United  States  Public  Health  Service  to  Lincoln  County 
to  assist  in  a  health  project  for  the  county.  About  500  school  children  were  examined 
and  they  and  their  parents  instructed  in  nutrition  and  other  matters  of  hygiene,  and 
in  many  cases  urged  to  consult  doctors  and  dentists. 

I«fk  After  about  foiu:  weeks  assistance  fi'om  the  Health  Service  the  home  demonstration 
agent  did  all  the  rest  of  the  work,  consisting  of  weighing  the  children  monthly  and 
instruction  of  both  cliildren  and  mothers. 

The  next  year  similar  work  was  done  under  the  direction  of  the  home  demonstration 
agent  with  only  the  assistance  of  local  doctors  and  dentists  and  mothers,  and  the  work 
extended  to  othersections  of  the  county. 

This  demonstrates  that  there  are  already  Government  agencies  doing  the  work; 
the  inspiration  and  help  of  the  United  States  Public  Health  Service. 
Mf  Home-demonstration  agents  are  trained  in  nutrition  and  hygiene  as  well  as  other 
phases  of  home  making.  However,  they  do  not  try  to  replace  the  physician  but  on 
the  other  hand  urge  his  employment.  In  turn  the  physicians  of  this  county  called 
upon  the  home-demonstration  agent  to  assist  them  and  their  patients  in  the  matter 
ot  diet. 

Undoubtedly  it  is  more  economical  to  use  agencies  akeady  in  existence. 
Respectfully, 

(Miss)  A.  Belle  Shelton, 

136  House  Office  Building. 

The  Chairman.  Is  there  anything  further,  Mr.  Hawes? 

Mr.  Hawes.  That  is  all,  IVIr.  Chairman. 

The  Chairman.  Is  Dr.  Martin  in  the  room? 

(No  response.) 

The  Chairman.  Is  Dr.  Lumsden  present? 

Dr.  Lumsden.  Yes,  sir. 

The  Chairman.  You  can  proceed,  by  arrangement  made  by  the  chairman,  until 
12.20  o'clock,  after  which  time  the  arrangement  is  to  allow  Miss  Robertson  to  make  a 
statement. 

Dr.  Lumsden.  Very  well. 

STATEMENT    OF    DR.    L.    L.    LUMSDEN,    UNITED    STATES    PUBLIC 

HEALTH  SERVICE. 

Dr.  Lumsden.  Mr.  Chairman  and  gentlemen  of  the  committee,  I  feel  very  much 
honored  to  have  an  opportunity  to  take  part  in  the  testimony  which  is  being  given 
before  this  committee.  For  over  20  years  I  have  been  interested  in  public-health 
work  and  consequently  in  public-health  legislation,  which  decides  whether  or  not  public* 


220  PUBLIC  PROTECTIOlSr   OF  MATEPvNITY  Aj^D  INFANCY. 

health  work  shall  be  done  and,  in  a  general  way,  how  it  shall  be  done.  In  the  course 
of  this  experience  I  have  attended  many  hearings  before  committees  of  the  House  and 
of  the  Senate  and  before  State  legislative  bodies  and  local  legislative  bodies.  I  have 
never  attended  a  hearing  which  impressed  me  as  being  any  fairer  than  the  one  which 
has  been  conducted  here.  I  have  never  attended  a  more  thorough  hearing.  Nor — 
and  I  say  this  because  I  feel  that  it  is  coming  to  the  committee — a  more  intelligent 
hearing.  I  appreciate  the  difficulty  that  the  committee  has  had  in  obtaining  the 
information  it  actually  wanted  from  some  of  the  witnesses  who  have  appeared  here,  . 
and  that  statement  probably  will  apply  after  I  testify,  because  I  am  likely  to  be 
in  that  number. 

I  am  going  to  try  to  discuss  this  matter  from  a  field  standpoint.  Much  of  the  testi- 
mony that  I  have  heard  here — I  have  not  heard  it  all — has  been  along  lines  which 
appeared  to  me  to  be  rather  foreign  to  the  subject.  Things  have  been  pointed  to  with 
pride  by  the  proponents  which  I  can  not  find  in  the  bill  and  which  judging  by  your 
cross  examination  you  haA^e  not  been  able  to  find  in  the  bill.  Things  have  been 
spoken  into  the  bill  and  viewed  with  alarm  by  the  opponents  which  I  am  unable  to 
find  in  the  bill. 

My  particular  interest  in  this  bill  is  because  of  my  working  experience  in  life. 
I  entered  the  public-health  field  because  I  liked  it,  because  I  thought  it  offered  a  big 
opportunity  for  service,  and  because  I  had  to  make  a  living  somehow.  I  have  been 
engaged  as  an  officer  in  the  Public  Health  Service  for  over  22  years.  For  the  last  10 
years  my  work  has  been  mainly  in  the  rural  districts,  which,  I  think,  present  the 
largest,  the  most  important,  and  the  most  difficult  part  of  the  public-health  situation 
in  the  United  States.  Our  large  cities  are  doing  very  well  for  themselves  along  public- 
health  work  lines.  In  public  health  work  I  include  the  work  contemplated  in  this 
bill  for  the  promotion  of  the  hygiene  of  maternity  and  infancy.  I  look  upon  it,  from 
my  studies  of  this  business,  as  distinctly  and  clearly  a  branch  of  public-health  work. 
We  can  not  draw  sharp  lines  of  demarcation  between  public-health  work,  social- 
service  work,  and  economic  work,  because  they  are  interwoven  absolutely.  When 
a  public-health  officer  goes  to  a  home  to  adAdse  the  family  what  to  do  to  prevent  the 
spread  of  diphtheria  or  tuberculosis,  or  any  other  infection,  he,  in  order  to  make 
his  work  effective,  must  consider — and  if  he  has  good  sense  he  will  consider — the 
economic  conditions  of  the  home  and  the  social  conditions  of  the  home.  When  a 
health  niu-se,  under  the  instruction  of  the  health  officer  of  the  community,  makes 
his  visit  to  a  family  she,  too,  must  consider  the  social  and  economic  conditions.  If 
there  be  a  poverty  factor  which  makes  it  inpossible  to  promote  hygiene  in  that  family,, 
then  it  is  a  distinct  duty  of  the  health  worker  to  go  to  whatever  agency  may  be  in  the 
community  which  is  or  can  be  made  available  for  assistance  to  relieve  that  poverty 
factor. 

Dr.  Williams  referred  to  the  sanitary  officers  engaged  in  some  of  the  counties  in 
Virginia  to  carry  out  a  highly  eonomical  plan  of  cooperative  health  work  supported 
with  funds  furnished  by  the  county  officials,  the  State  board  of  health,  and  the  Public 
Health  Service.  In  one  of  those  counties  a  few  weeks  ago  the  sanitary  officer  was 
called  by  a  family  to  see  a  house  servant  who  had  on  her  iice  some  kind  of  an  eruption 
which  the  family  was  fearful  might  be  scarlet  fever  or  something  else  contagious. 
The  servant, /a  colored  woman,  worked  irregularly  as  cook,  laundress,  and  nurse,  and 
assistant  in  the  care  of  the  children  not  only  in  that  family  but  in  several  other  fam- 
ilies in  the  neighborhood.  The  sanitary  officer  not  being  a  doctor  got  a  local  private 
practitioner  of  medicine  to  go  with  htm  to  see  the  case.  They  found  the  woman 
to  be  in  a  highly  contagious  stage  of  virulent  syphilis.  There  was  no  doubt  about  the 
diagnosis,  and  there  was  that  woman  helping  to  take  care  of  15  or  20  children  in 
that  neighborhood.  She  was  entirely  ignorant  of  the  serious  risk  to  which  she  was 
exposing  those  innocent  children.  She  herself  was  pregnant.  Going  to  10  homes  in 
the  neighborhood  the  sanitary  officer  asked  each  family  to  contribute  $5,  and  with 
the  $50  the  woman,  after  conditions  were  explained  to  her,  and  with  her  full  consent, 
was  taken  on  a  train  to  the  hospital  at  Charlottesville,  Va.,  and  put  under  care  and 
treatment.  That  was  an  instance  of  a  sanitary  officer  doing  social-seiAdce  work, 
but  doing  it  under  public-health  administration  as  a  part  of  his  public-health  work. 

As  I  understand,  the  purpose  of  this  bill  is  the  promotion  especially  of  the  hygiene 
of  maternity  and  infancy.  It  seems  that  the  provision  in  the  first  section  of  the  bill 
about  promoting  the  care  of  maternity  and  infancy  is  very  general  and  somewhat 
vague.  I  do  not  know  what  might  not  be  done  under  a  literal  construction  of  such 
authorization.  It  seems,  though,  that  the  plans  of  detailed  procedure  would  be  pro- 
posed by  the  State  agency  and  be  subject  to  the  approval  of  the  Children's  Biu-eau. 
I  would  not  expect  the  State  agency  and  the  Children's  Bureau  to  agree  upon  a  plan 
embodying  some  of  the  absurd  things  which  have  been  suggested  as  possibilities 
before  this  committee.     If  under  the  broad  authorization  absurd  Lines  of  activity 


PUBLIC  FROTECTION   OF    MATERNITY  AND  INFANCY.  221 

were  undertaken  with  this  money  I  would  not  expect  the  personnel  responsible  to 
stay  in  office  but  a  short  time.  I  have  some  confidence  in  human  intelligence — even 
in  that  of  oiir  <>:overnmental  agencies. 

Mr.  HocH.  Doctor 

Dr.  LuMHDEN  (interposing;).  If  I  may  be  permitted  to  complete  my  statement, 
I  probably  shall  an.swer  your  cjuestifjii. 

Mr.  Mapes.  There  was  one  thought 

Dr.  LuMsuEN  (interposing)/  I  perfer,  if  I  may,  to  complete  this  general  statement, 
because  my  time  is  so  limited. 

I  have  read  carefully  the  hearings  on  this  bill  held  before  the  House  committee 
in  the  last  session  and  before  the  Senati;  committee  in  the  present  session  of  Congress. 
From  then  and  other  possible  sources  of  information  1  have  endeavored  to  ascertain 
whether  what  is  contemplated  actually  to  be  done  under  this  bill  would  be  health 
work  or  not.  If  the  provisions  were  for  ''])urely  and  distinctly  social-service  work." 
as  some  sec^m  to  think.  I  siiould  not  feel  (|uali(ied  to  discuss  the  measure  ex"cept  in 
very  general  terms.  It  seems  to  me,  however,  that  the  acti\T.ties  under  this  bill 
would  i)e  more  nearly  public-health  work  than  anything  else.  In  this  connection 
the  testimony  of  the  head  of  tlie  (-hildren's  Bureau  and  her  assistants,  who  originally 
drafted  this  bill  and  who  would  constutite  the  authorized  I'^deral  agency  to  deter- 
mine what  should  be  done  under  this  bill  if  it  were  enacted  into  law,  is  illuminating. 
I  find  Ihit  at  the  hearing  (]>.  21)  before  this  committee  on  the  bill  IT.  R.  10925,  in 
the  Sixty-sixth  Congress.  Mr.  Winslow,  in  questioning  Miss  Lathrop,  the  head  of  the 
Children's  Bureau,  asked: 

''You  would  naturally  look  to  the  trained  nurse  as  the  field  agent,  would  you  not? 
'"Miss  L.\TiiK()i'.  1  would  certainly  employ  trained  nurses. 

''Mr.  WiNHLOW.  And  then  your  next  source  of  Consultation  might  be  the  physicians 
of  the  neighborhood? 

"Miss  L.\THR()P.  Of  course,  both  physicians  and  nurses  would  ])e  necessary  in  the 
States." 

This  is  of  especial  interest,  because  the  field  work,  the  actual  work,  would  be  done 
in  the  States;  it  would  not  be  done  in  Washington.     Miss  Lathrop  continues: 

''We  must  also,  I  think,  have  what  has  helped  to  give  New  Zealand  the  lowest 
infant  death  rate  in  the  world,  a  rate  about  half  of  our  own  country — namely,  interest 
and  wisdom  to  create  hospitals  and  to  create  nursing  services  and  other  necessary 
activities  locally." 

That  statement  would  seem  to  indicate  that  Miss  Lathrop  is  of  the  opinion  that 
the  operation  of  a  big  medical  or  public-health  factor  would  be  necessary  to  the  accom- 
plishment of  the  general  purpose  of  this  bill. 

At  the  bottom  of  page  21  of  those  hearings,  with  Mr.  Winslow  still  questioning 
Miss  Lathrop,  this  occiu'red: 

''Mr.  Winslow.  Well,  how  is  it  in  the  rural  localities  as  compared  with  the  cities? 
"Miss  Lathrop.  The  maternal  mortality  in  the  isolated  rural  sections  is  markedly 
high,  and  it  is  markedly  a  matter  of  neglect — not  altogether  neglect  of  doctors,  but 
lack  of  opportunity  for  care  <and  information,  which  could  all  be  secured  under  this 
bill,  first,  by  printed  information,  by  popular  teaching,  by  public-health  nursing; 
and  lastly,  by  a  proper  system  of  district  medical  service  for  exceptional  need." 

That  statement  by  Miss  Lathrop  interested  me  especially,  because  public  health 
work,  including  public-health  nursing  in  the  rural  districts,  is  the  line  of  business  ^ 
with  which  I  am  connected  in  the  Pnolic  Health  Service. 

Incidentally — I  believe  it  has  already  been  brought  out  several  times  at  this  hear- 
ing— the  puerperal  mortality,  the  so-called  "maternity  mortality,"  in  our  birth 
registration  area  is  somewhat  lower  in  the  rural  districts  than  it  is  in  the  cities.  I 
think  that  is  a  point  which  should  be  given  consideration. 

Now,  coming  to  the  hearings  before  the  Committee  on  Education  and  Labor,  United 
States  Senate,  Sixty-Feventh  ('ongre^s,  first  fe^t-ion,  on  S.  1039,  a  bill  for  the  public 
protection  of  luaternity  and  infancy  and  providing  a  method  of  coopeation  between 
the  Government  of  the  United  State?  and  the  several  State.=5,  which  once  was  the  same 
as  H.  R.  2366,  the  bill  you  now  a^-e  considering,  let  us  see,  further,  if  there  is  any  further 
testimony  to  indicate  whether  this  is  a  public-health  measure.  Miss  Lathrop,  in 
answering  a  question  about  economy  by  Senator  McKellar,  made  this  statement  (see 
p.  22): 

"The  law  provides  the  e.^tablishment  of  local  health  centers  and  of  inftructive 
public-health  nursing  as  a  part  of  a  state  plan,  and  it  would  be  the  duty  of  the  l^ureau, 
as  I  conceive  it,  to  publish  and  distribute  widely  all  the  be=t  availal)le  practical 
information  as  to  character,  organization,  and  management  of  such  centers  and  nursing 
service." 

On  page  23  of  that  hearing.  Miss  Lathrop,  in  answering  a  question  about  the  relation 
which  the  Woman's  Bureau  might  have  to  the  matter  under  discussion,  says: 


222  PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY. 

"I  do  not  think  that  a  bureau  devoted  to  the  interest  of  wage-earning  women  is  in  a. 
position  to  take  up  this  technical  piece  of  work  in  which  we  have  been  engaged  for 
nine  years." 

As  there  has  been  so  much  said  aVjout  the  nontechnical  percentage  of  this  work,  1 
think  that  statement  should  be  of  interest.  It  seems  Miss  Lathrop  thinks  there  is  a. 
technical  phase  in  the  work  which  would  be  done  under  this  bill.  I  agree  there  is. 
I  do  not  see  how  anyone  who  knows  something  of  pubhc-health  work  can  possibly 
escape  such  conclusion. 

Now,  we  go  to  page  75  of  those  hearings.  Miss  Lathrop  takes  the  stand  to  make  an 
explanation.  She  quotes  from  section  8  of  the  bill,  which  is  the  same  as  section  8 
of  H.  R.  2366,  and  then  says: 

"Of  course,  that  is  what  we  depend  on  more  than  anything  else." 

"The  popular,  nontechnical  instruction  provided  for  in  section  9,  to  be  given  by 
qualified  lecturers  on  hygiene  and  maternity  and  information  on  related  subjects  is  a. 
measure  of  importance  in  our  opinion.  By  related  subjects  is  meant  the  arts  of  the- 
household,  such  as  cookery  and  other  methods  of  sanitary  and  healthful  home  manage- 
ment." 

From  this  statement  it  appears  that  agents  functioning  under  the  provisions  of  this 
bill  would  be  expected  not  only  to  engage  in  sanitary  or  public-health  work,  but  also 
enter  the  field  of  home  economics  and  domestic  science,  which  already  is  occupied  by 
agents  of  the  Department  of  Agriculture. 

When  I  reached  page  137  of  that  Senate  hearing  I  found  what  promised  to  be  a  very 
interesting  statement.  I  thought  here  is  where  I  am  to  learn  what  this  bill  is  all  about. 
Dr.  Florence  McKay,  assistant  director  of  the  Children's  Bureau,  was  testifying.. 
She  states: 

"I  am  assistant  director  of  the  hygiene  division  of  the  Children's  Bureau. 

"The  Chairman.  In  Washington? 

"Dr.  McKay.  In  Washington.  A  number  of  people  have  m.ade  statements  concern- 
ing the  standard  of  the  work  that  is  to  be  undertaken  if  this  bill  for  the  protection  of 
maternity  and  infants  goes  through.  I  wish  to  state — "  and  my  heart  sank  when  the 
•chairman  at  that  point  interrupted  her  with  a  question,  because  I  thought  I  was 
about  to  learn  just  what  would  be  the  standard  of  the  work  to  be  accepted  by  the 
Children's  Bureau  if  this  bill  were  enacted.  But  the  chairman  interrupts  her  with 
a  question: 

"The  Chairman.  Are  you  a  physician? 

"Dr.  McKay.  Yes;  I  am  a  physician. 

"The  Chairman.  How  many  physicians  are  connected  with  the  Children's  Bureau?' 

"Dr.  McKay.  At  present  there  are  four.  The  number  of  physicians  varies  accord- 
ing to  the  amount  of  work  we  have  to  do.  They  are  not  only  regular  physicians, 
but  hey  are  physicians  trained  in  child-hygiene  work  and  they  have  had  special 
experience  along  that  line." 

And  now  she  resumes  her  statement;  I  am  very  glad  she  does,  and  I  think  all  of  us' 
ought  to  be.  I  congratulate  Dr.  McKay  upon  her  continuity  of  thought.  She 
continues:  • 

"As  an  outcome  of  the  child  work  there  was  held  in  Washington  and  in  various- 
regions  throughout  the  country  a  series  of  conferences  which  resulted  in  standardizing 
the  child-hygiene  work  of  this  country. 

"These  standards  have  been  published,  and  I  would  like  to  file  with  the  Senators- 
here  copies  of  them  so  that  they  can  see  what  the  work  for  maternity  and  infancy 
will  be. 

"On  page  6  of  this  you  will  find  the  minimum  standard  for  public  protection  of  the- 
health  of  mothers  and  children.  These  standards  were  agreed  upon  by  authorities- 
not  only  from  this  country  but  from  various  countries  which  sent  their  best  people- 
to  this  country,  and  as  the  result  of  these  conferences,  these  minimum  standards  for- 
public  protection  of  the  health  of  mothers  and  children  resulted.  These  minimum 
standards,  as  you  all  have  noticed — I  will  not  read  them — but  they  contain  provisions 
for  maternity  of  prenatal  centers  sufficient  to  provide  for  all  cases  not  receiving 
prenatal  supervision  from  private  physicians,  and  provide  for  physicians  and  nurses 
in  these  centers  with  clinics  for  dental  and  venereal  treatment,  for  maternity  hospitals, 
or  for  maternity  wards  in  general  hospitals,  the  regulation  of  midwives,  and  for  the- 
adequate  income  to  allow  the  mother  to  remain  in  the  home  through  the  nursing 
period,  and  so  on. 

"Now  this  work,  if  this  maternity  bill  goes  through,  would  be  guided  according  to- 
these  minimum  standards  and  also  with  the  advice  of  the  best  obstetricians  of  the 
country. ' ' 

Now,  that  was  Dr.  McKay's  idea  of  what  would  be  done  if  the  bill  were  enacted 
into  law,  and  Dr.  McKay  was  in  a  position  to  know  what  she  was  talking  about. 
I  think  they  would  be  perfectly  right  in  doing  public-health  work  if  this  bill  were- 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  223 

enacted  in  its  present  form,  because  they  could  not  get  anywhere  in  promoting  the 
hygiene  of  maternity  and  infancy  without  either  doing  public-health  work  or  having 
it  done  by 'somebody  else. 

And  now  I  am  coming  to  the  main  point,  I  think,  to  be  considered  in  connection 
with  the  demands  made  upon  Congress  for  health  legislation.  I  think  the  e  demands 
will  continue  to  come  upon  you,  and  if  they  be  logical  I  sincerely  hope  they  will. 
I  shall  be  distinctly  disappointed  in  the  citizens  of  this  country  if  they  do  not  make 
demands  upon  the  "Congi-ess  for  the  legislation  which  Congress  properly  may  enact  for 
the  protection  and  the  promotion  of  the  health  of  not  only  the  mothers  and  the  babies 
but  of  all  the  people  of  the  United  States.  The  interests  of  the  men,  women,  and  chil- 
dren are  inextricably  bound  together,  and  one  age-sex  group  can  not  be  well  off  with- 
out the  others  being  well  off.  We  can  not  consider  the  interests  of  the  women  apart 
from  the  interests  of  the  men,  and  God  help  us  if  we  ever  seriously  undertake  to  do  so. 

In  considering  heallh  or  any  other  proposed  legislation,  perspective  is,  of  course, 
always  important,  and  it  appears  critically  important  at  this  time.  How  can  you  invest 
from' our  hard-worked,  depleted  Treasury  at  the  present  time  so  as  to  give  to  the 
people  of  the  United  States  the  best  dividend  yield?  The  people  have  put  the  money 
into  your  hands  for  investment — how  can  you,  as  directors  for  those  stockholders, 
invest  the  money  to  the  best  lasting  benefit  of  the  men,  women,  and  children  of  this 
country?  Can  you  do  it  in  the  field  of  health  legislation  by  the  enactment  of  a  measure 
which  "will  establish  and  put  into  the  field  a  specialized  force  of  health  workers  who 
will  engage  in  but  one  branch  of  health  work  constituting  only  about  one-tenth  or 
one-fifteenth  of  what  we  call  a  well-balanced  health  program  to  meet  the  needs  of  the 
people  of  the  United  States?  If  you  are  going  to  create  by  the  enactment  of  this  bill 
a  highly  specialized  force,  with  overhead  expenses  and  incidental  and  traveling 
expenses — and  the  traveling  expenses  will  be  a  considerable  item  under  this  bill — 
to  look  after  one  group  of  our  citizens,  can  you  stop  there?  Do  you  think  you  can 
stop  there?  Don't  you  think  that  there  will  be  in  a  few  weeks  or  in  a  few  months 
a  large  representation  of  men  voters  and  women  voters  coming  here  to  ask  that  you 
do  something  about  tuberculosis,  and  scarlet  fever,  and  diphtheria,  venereal  diseases, 
and  other  diseases?  Finally,  the  old  wise  ones  may  come  to  ask  you  to  do  something 
for  old-age  life-extension  hygiene.  I  may  be  in  that  party.  I  think,  gentlemen,  if 
you  enact  this  bill,  you  will  be  starting  on  a  program  which  for  its  logical  completion 
will  require  enactment  for  the  estabishment  of  15  or  more  specialized  Federal  health 
organizations. 

To  cooperate  with  the  Federal  agencies  the  creation  of  corresponding  State  and  local 
agencies  would  be  necessary,  and  the  burden  of  expense  for  such  services  would  be 
so  great  that  the  people  could  not  and  would  not  think  of  standing  it. 

I  know  something  of  the  needs  of  the  average  rural  community  in  the  United  States. 
Dr.  Williams  spoke  of  hookworm,  and  malaria,  and  typhoid  fever.  I  have  worked 
in  communities  in  which  75  per  cent  of  the  population  have  malaria  every  year. 
If  you  should  send  a  specialized  force  into  such  a  community  to  work  on  infancy  and 
maternity  hygiene  alone,  through  social  service  or  any  other  methods,  the  people 
would  be  disappointed.  They  would  say,  "We  want  some  one  to  come  here  to  teach 
us  how  and  help  us  to  get  rid  of  malaria.  That  is  what  is  pulling  down  our  women 
and  children  and  men;  that  is  the  thing  that  is  putting  the  burden  on  maternity  and 
is  the  cause  of  50  or  75  per  cent  of  our  sickness.  We  want  to  get  rid  of  malaria. ' '  Other 
communities  would  substitute  for  malaria  hookworm,  pellagra,  tuberculosis,  or  some 
other  disease,  and  say  the  same.  That  which  seems  clearly  to  be  critically  needed  is 
a  progi'am  of  general  health  work  which  can  be  administered  by  one  cooperating 
agency  and  which  can  be  applied  so  as  to  assist  in  furnishing  local  health  service  to 
meet  in  reasonable  sequence  the  actual  needs  of  local  situations. 

Immediately  across  the  Potomac  River  from  here,  in  Arlington  County,  Va.,  is 
being  carried  on,  under  the  direction  of  a  well-qualified,  whole-time  county  health 
officer,  what  I  regard  as  a  well-balanced  general  program  of  rural  health  work.  In 
that  county  all  salient  branches  of  health  work — including  general  sanitation,  com- 
municable" disease  control,  school  inspection,  infant  and  maternity  hygiene,  etc. — 
are  being  carried  out  under  one  direction  with  one  administration  or  overhead  expense. 
The  continual  question  with  the  local  health  officer  is  "what  can  be  done  with  the 
resources  availalDle  that  will  do  the  most  good."  By  his  sense  of  relatiye  values  he 
proceeds  •with  either  success  or  failure.  The  work  in  Arlington  County  is  under  one 
head,  and  one  clerk  attends  to  the  clerical  work  in  the  office.  If  you  had  six  special- 
ized organizations  over  there  working  under  six  different  heads  there  would  have 
to  be  at  least  six  clerks  to  write  up  the  reports  at  the  end  of  the  day  or  the  week  or  the 
month. 

Some  one  has  said  that  the  poorest  market  to-day  in  the  world  for  "gold  bricks"  is 
among  the  farming  population  in  the  rural  districts  of  this  country.     In  order  to  get 


224  PUBLIC   PROTECTION   OF   MATERNITY  AND   INFANCY, 

the  local  authorities  in  our  rural  sections  to  invest  for  local  health  work  they  must  be 
convinced  that  the  proposition  is  sensible  and  economical.  They  have  a  limited 
amount  of  money  to  invest,  and  they  want  to  know  what  it  will  do.  I  should  feel  sad 
if  I  were  given  the  responsibility  of  selling  to  the  rural  communities  throughout  the 
United  States  any  one  highly  specialized  branch  of  health  work.  What  particular 
branches  of  health  work  are  indicated  in  a  given  locality  must  be  determined  by  care- 
ful local  studies.  I  can  not  determine  here  in  an  office  in  Washington,  and  Dr. 
Williams  in  his  office  in  Richmond  can  not  determine  how  the  money  available  for 
health  work  can  be  spent  to  the  best  advantage  in  a  given  community;  that  has  to  be 
determined  by  some  one  on  the  local  job.  The  question  of  administration,  or  whether 
the  reports  are  sent  to  one  bureau  or  another  in  Washington,  is  not  so  material. 

The  Chairman.  Doctor,  you  have  about  10  minutes  more,  including  questions  from 
the  committee. 

Dr.  LuMSDEN.  Thank  you,  Mr.  Chairman.  The  resolutions  which  were  presented 
by  Dr.  Williams  seem  very  clear  in  their  meaning.  Those  resolutions,  adopted  after 
thorough  deliberation,  present  the  latest  verdict  of  our  State  health  officers  on  the  kind 
of  health  legislation  needed  from  the  Federal,  State  and  local  Governments  in  the 
United  States.  They  contemplate  cooperation  for  the  establishment  and  maintenance 
of  local  health  service  to  carry  out  the  general  program  of  health  work  needed. 

The  State  health  officers  from  practically  every  State  in  the  Union  appear  to  think 
that  the  Federal  Government's  part  in  the  public  health  br.siness  should  be  adminis- 
tered by  one  agency  in  one  department.  That  seems  good  judgment;  it  seems  good 
common  sense  to  prevent  duplication  and  to  save  overhead  expenses.  The  Public 
Health  Service  is  now  engaged  with  a  small  annual  appropriation  of  $50,000  in  doing 
demonstration  work  in  rural  sanitation.  At  the  present  time  we  are  working  in  35 
States,  one  or  two  counties  in  a  State,  trying  to  do  the  best  we  can  with  that  small  sum 
of  money  to  demonstrate  what  local  health  ser\dce  with  the  aid  of  Federal  and  State 
Governments  can  do. 

And,  gentlemen,  it  is  demonstrated.  I  am  going  to  leave  with  you  the  report  on 
that  work  for  the  fiscal  year  1920.  The  report  for  the  year  1921  has  not  yet  been  pub- 
lished. This  reprint  No.  615  will  give  you  an  idea  of  what  it  means.  We  do  not 
use 

Mr.  Hawes  (interposing).  May  I  inteiTupt  you  just  there:  Will  you  please  pat  ex- 
tracts of  that  report  into  the  record;  take  extracts  giving  information,  and  put  it  in 
the  record? 

Dr.  LuMSDEN.  I  can  do  that  if  permitted. 

Mr.  Hawes.  Yes. 

Dr.  LuMSDEN.  I  shall  be  glad  to  do  that. 

(The  following  excerpts  from  the  report  were  submitted  later  on  by  Dr.  Lumsden  for 
insertion  in  the  record:) 

"During  the  fiscal  year  ended  June  30,  1920,  cooperative  projects  were  carried  out 
in  31  counties  in  11  States.  To  meet  the  expenses  of  this  cooperative  work,  a  total  of 
1175,093.88  was  furnished  and  expended  from  community,  county,  and  State  govern- 
mental sources,  and  $54,001.47  from  civic  sources,  such  as  local  health  associations, 
Red  Cross  chapters,  and  the  International  Health  Board.  Thus,  this  investment  of 
Federal  funds  has  been  met  with  odds  of  about  5  to  1,  which  indicates  unmistakably 
that  such  investment  of  Federal  funds  stimulates  to  a  significant  degree  State,  county, 
and  municipal  governments  to  invest  in  the  business  of  rural  health  promotion. 

"The  scope  and  the  results  of  the  work  and  the  funds  expended  from  the  different 
sources  are  presented  in  the  accompanying  tabular  statement. 

"plan   or   WORK. 

"In  every  instance  the  cooperation  of  the  Public  Health  Service  is  extended  only  in 
response  to  formal  requests  from  the  proper  governmental  authorities  of  the  county 
and  from  the  State  health  department.  A  preliminary  survey  of  the  situation  is  made 
by  a  representative  of  the  State  health  department  or  a  representative  of  the  Public 
Health  Service  or  both.  From  the  data  obtained  in  the  preliminary  survey  the 
general  plan  of  work  to  be  carried  out  and  the  amount  of  funds  necessary  to  secure  the 
definite  resiilts  desired  are  agreed  to  by  the  several  agencies  which  are  to  cooperate  in 
the  project. 

"The  different  branches  of  health  work  indicated  in  the  county  are  taken  up  in 
what  appears  to  be  the  logical  and  most  advantageous  sequence.  Every  salient 
branch  of  health  work — ^including  safeguarding  of  water  and  food  supplies,  sanitary 
excreta  disposal,  fly  control,  antimalarial  measures,  infant  hygiene,  school  inspection, 
antituberculosis  and  antivenereal  disease  measures,  industrial  hygiene,  etc. — ^is  carried 
out  in  the  demonstration  units.  Thus,  the  work  is  comprehensive,  and  it  can  be 
adjusted  for  advantageous  cooperation  from  the  various  and  sundry  governmental  and 
extra-governmental  health  agencies  which  have  been  created  for  one  reason  or  another. 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  225 


"Everyone  of  the  cooperative  projects  in  the  fiscal  year  ended  June  30, 1920,  yielded 
results  exceeding  in  value  manyfold  the  cost  in  laljor  and  money.  Among  the  total 
results  indicated  in  the  tabular  statement,  to  which  especial  consideration  may  be 
given,  are: 

' '  1 .  Public  health  lectures  presenting  the  ])rinciple8  and  details  of  sanitation  to  over 
83,000  persons. 

"2.  Over  150,000  sanitary  inspections  of  private  homes,  with  plain  discussion  of  the 
findings  being  made  in  almost  all  instances  with  meml;ers  of  the  households. 

"3.  Physical  examination  of  over  45,000  school  children,  with  notification  of 
parents  resulting  in  the  institution  of  corrective  measures  among  a  considerable  pro- 
portion of  th(;  27,031  children  who  were  found  to  have  more  or  less  incapacitating 
physical  defects. 

"4.  Eighteen  thousand  eight  hundred  and  seventy-two  visits  by  health  nurses  to 
homes  of  cases  of  communicable  disease,  to  advise  and  show  the  afflicted  households 
how  to  prevent  the  spread  of  the  infections. 

"5.  Six  hundred  and  seventy  visits  by  health  nurses  to  advise  with  and  assist 
expectant  mothers  in  carrying  out  hygienic  and  physiological  measures  making  for 
healthy  mothers  and  healthy  babies. 

'"6.  Five  thousand  four  hundred  and  twenty-eight  home  \isits  by  health  nurses  to 
demonstrate  hygienic  measures  for  the'  prelection  of  the  health  and  lives  of  infants. 

"7.  Nineteen  thousand  three  hundred  and  seventy  persons  vaccinated  for  pro- 
tection against  smallpox,  a  disease  which  now  should  be  obselete  and  which  can  be 
made  so  by  thorough  vaccination. 

"8.  Twenty-one  thousand  two  hundred  and  three  treatments  to  free  persons  of 
venereal  disease  infection  and  prevent  the  spread  of  the  infection. 

"9.  Four  thousand  one  hundred  and  fifty-one  cases  of  dangerous  communicable 
disease  quarantined  to  prevent  spread  of  infection  in  the  community,  the  State,  and 
throughout  the  country. 

"id.  The  installation  of  16,250  sanitary  pri\ies  at  homes  previously  provided  with 
grossly  insanitary  priiies  or  without  toilets  of  anv  sort. 

"11.  One  thousand  one  hundred  and  seventy-eight  homes  provided  with  clean 
water  suppliesin  place  of  contaminated  water  supplies. 

"12.  Radical  improvement  of  494  public  milk  supplies,  distributed  to  a  consider- 
able extent  through  the  channels  of  interstate  commerce,  to  prevent  the  spread, 
through  the  enriching  medium  of  milk,  of  such  infections  as  those  of  typhoid  fever, 
scarlet  fever,  diphtheria,  tuberculosis,  septic  sore  thi-oat,  and  infant  diarrhea. 

"Among  the  demonstration  units  in  which  remarkable  reduction  in  sickness  and 
death  rates  has  followed  the  sanitary  improvements  accomplished  is  Madison  County, 
Ala.  In  this  county,  with  a  population  of  50,000,  the  cooperative  work  was  begun 
in  the  latter  part  of  the  calendar  year  1917.  The  reduction  in  deaths  for  the  year 
1919,  as  compared  with  1915,  1916,  and  1917,  which  appeared  definitely  to  result 
from  the  sanitary  improvements  accomplished,  amounted  to  a  saving  in  that  year  of 
over  150  human  lives.  The  total  cost  of  the  health  work  in  that  county — met  with 
funds  from  local.  State,  and  national  governmental  sources — was  for  each  of  the  cal- 
endar years  1918  and  1919  about  $10,000.  The  saving  of  the  lives  of  American  citizens 
at  a  cost  of  S66  per  life  saved  seems  a  reasonably  good  investment." 

The  Chairman.  Doctor,  it  is  either  a  question  of  your  not  being  asked  any  ques- 
tions by  the  committee,  or  you  should  submit  to  questions  now. 

Dr.  LuMSDEN.  I  shall  be  glad  now  to  answer  questions. 

The  Chairman.  I  will  give  Mr.  Mapes  an  opportunity  to  examine  you.  Your 
statement,  questions  and  all,  will  have  to  be  concluded  in  seven  nainutes. 

Mr.  Mapes.  You  have  read  excerpts  from  hearings  here  of  different  witnesses  for 
the  purpose,  I  take  it.  of  criticizing,  or  calling  attention  to  their  interpretation  of  the 
authority  which  would  be  given  under  this  bill. 

Dr.  LuMSDEN.  I  shall  be  glad,  if  possible,  to  give  yes  and  no  answers  to  the  inquiries. 

Mr.  Mapes.  I  am  afraid  you  can  not  answer  my  inquiries  that  way.  I  wish  you 
would,  for  my  information,  tell  me  where  the  Public  Health  Service  gets  its  authority 
under  the  law  to  do  the  work  which  this  bill  contemplates. 

Dr.  LuMSDEN.  In  the  first  place,  my  quotations  fi-om  the  previous  hearings  were 
to  indicate  upon  what  information  I  based  my  conclusion  that  the  work  contemplated 
by  this  Sheppard-Towner  bill  is  regarded  by  the  Children's  Bureau  as  public  health 
work.  The  Public  Health  Service  has  authority,  under  the  act  of  1912,  to  investigate 
the  diseases  of  man  and  the  conditions  influencing  them.  There  is  an  investigative 
phase  to  all  the  work  we  do. 

74654—21 15 


226  PUBLIC  PEOTECTIOlSr   OF   MATERNITY  AND   INFANCY. 

Mr.  Mapes.  Investigate  what? 

Dr.  LuMSDEN.  Diseases  of  man  and  the  conditions  pertaining  thereto. 

Mr.  Mapes.  Contagious  diseases? 

Dr.  LuMSDEN.  No;  "the  diseases  of  man; "  it  is  not  limited  to  contagions. 

Then,  in  regard  to  the  demonstration  work — in  Arlington  County,  Va.,  for  instance, 
we  are  cooperating  with  the  State  board  of  health 

Mr.  Mapes.  Just  answer  my  question  in  the  briefest  possible  way.  We  have  such 
brief  time. 

Dr.  LuMSDEN.  I  am  trying  to  answer  your  question  and  say  what  I  think  at  the  same 
time. 

Mr.  Mapes.  Now.  I  am  asking  you  to  give  me  the  law;  where  that  appears? 

Dr.  LuMSDEN.  The  authority  for  the  cooperative  demonstration  work  in  rural 
sanitation  is  carried  in  the  sundry  civil  bills  from  year  to  year. 

Mr.  Mapes.  Does  that  include  the  protection  of  mothers  and  prenatal  care? 

Dr.  LuMSDEN.  .Sanitation  is  a  broad  term,  and  the  hygiene  of 

Mr.  Mapes  (interposing).  You  criticized  the  proponents  of  this  bill  for  proposing 
to  do  certain  things  which  the  Public  Health  Service  evidently  is  doing. 

Dr.  Lumsden.  I  want  to  answer  your  question.  In  each  of  those  counties  in  which 
we  are  working,  there  is  a  county  health  organization.  We  pay  about  one-seventh 
of  the  expense. 

Mr.  Mapes.  We  will  not  have  time  to  discuss  that. 

Dr.  Lumsden.  We  put  our  money  in  with  the  local  money,  and  the  local  health 
officer  ^vith  the  combined  funds  carries  out  the  program  of  sanitation  (or  hygiene). 

Mr.  Mapes.  Now,  I  would  like  to  call  attention  to  the  law  which  creates  the  Chil- 
dren's Bureau. 

Dr.  Lumsden.  I  know  that  law,  sir.  I  am  thoroughly  familiar  with  it.  They  have 
so  far  as  investigation  of  conditions  of  children  is  concerned  a  range  as  mde  as  the 
horizon. 

Mr.  M4PES.  They  have  a  great  deal  more  right  under  the  law  to  do  this  very  work 
contemplated  under  this  bill. 

Dr.  Lumsden.  I  have  not  disputed  their  rights  to  do  what  they  are  doing. 

Mr.  Mapes.  I  would  like  to  put  this  in  the  record  for  the  benefit  of  those  who  read 
the  record: 

"The  said  bureau  shall  investigate  and  report  to  the  said  department  upon  all 
matters  pertaining  to  the  welfare  of  children  and  child  life  among  all  classes  of  our 
people,  and  shall  especially  investigate  the  questions  of  infant  mortality,  the  birth 
rate,  orphanage,  juvenile  courts,  desertion,  dangerous  occupations,  accidents  and 
diseases  of  children,  employment,  legislation  affecting  children  in  the  several  States 
and  Territories. " 

This  rural  sanitation  pro^^-sion  under  the  sundry  civil  bill,  I  notice,  contains  this 
provision : 

"That  no  part  of  this  appropriation  shall  be  available  for  demonstration  in  rural 
salutation  in  any  community,  unless  the  State,  coimty,  or  municipality  in  which  the 
community  is  located  agrees  to  pay  one-half  of  the  expenses  of  such  demonstration 
work. " 

Do  you  think  that  is  a  wise  proidsion? 

Dr.  Lumsden.  I  do.     I  think  the  general  Government 

Mr.  Mapes  (interposing).  I  just  asked  you  if  you  think  that  is  a  wise  provision. 

Dr.  Lumsden.  I  do;  I  would  like  to  elaborate  in  that  answer  just  a  little.  I  think 
the  Federal  Government  should  be  interested  in  the  health  of  the  people  of  every  com- 
munity in  the  United  States  and  should  work  within  its  proper  limitations  with  the 
State  government  and  the  local  government  and  the  individual  through  sensible ^ 
economical  methods  for  the  promotion  of  human  health.  I  think  we  can  go  into  it 
perfectly  properly. 

Mr.  Webster.  Mr.  Chairman,  I  would  like  to  ask  a  question. 

The  Chairman.  Proceed. 

]VIr.  Webster.  Doctor,  I  understood  you  to  contend  that  the  administration  of  the 
bill  that  we  are  now  considering  shoidd  be  placed  in  the  Public  Health  Service  for  the 
reason  that  it  is  largely  a  medical  matter  and  involves  scientific  skill  in  its  administra- 
tion? 

Dr.  Lumsden.  I  think  this,  that  either  this  branch  of  public  health  work  should  be 
put  in  the  Public  Health  Service,  or  all  of  the  work  that  the  Public  Health  Service  is 
doing  along  public-health  lines  should  be  put  under  the  Children's  Bureau,  or  some 
other  bureau,  where  it  could  all  be  done  under  one  head,  in  one  department.  I  am 
trying  to  be  entirely  unbiased. 

Mr.  Webster.  Suppose  we  look  at  the  other  side  for  a  moment:  Sui)pose  this  partic- 
ular bill  should  be  transferred  to  the  Public  Health  Service  because  of  its  public-health 


PUBLIC   PROTECTIOiSr   OF    MATERNITY   AND   INFANCY.  227 

features,  what  do  you  say  about  the  powers  which  are  defined  by  the  act  creating  the 
Children's  Ihireau. 

"The  said  bureau  shall  investigate  and  report  to  said  department" — 

That  is.  the  Department  of  Commerce  and  Labor — 
"upon  all  matters  pertaining  to  the  welfare  of  children  and  child  life  among  all  classes 
of  our  people,  and  shall  especially  investigate  the  questions  of  infant  mortality,  the 
birth  rate,  orphanage,  juvenile  courts,  desertion,  dangerous  occupations,  accidents 
and  diseases  of  children,  employment,  legislation  affecting  children  in  the  several 
States  and  Territories." 

Now.  if  tlie  administration  of  this  particular  measure  should  be  committed  to  the 
Public  II(;alth  Service  because  of  its  medical  aspect,  why  should  not  the  entire  duties 
of  the  Children's  Bureau  be  transferred  to  the  Public  Health  Ser\-ice? 

Dr.  T.UMSDEN-.  I  think  all  of  the  investigative  matters  along  distinctly  health  lines 
should  be  ])laced  imder  one  service.     I  am  arguing  for  a  unified  Federal  health  service. 

From  a  standpoint  of  economy  and  efficiency,  I  can  not  advocate  this  bill  in  its 
present  shape.  I  am  in  favor  of  the  general  purpose  of  the  bill ;  no  one  reasonably  could 
be  opposed  to  the  general  purpose.  But  I  think  this  bill,  in  its  present  form,  would 
be  an  imeconomical  program  with  wliich  to  burden  any  biireau  or  Service  or  Depart- 
ment. I  think  its  enactment  in  its  present  form  woidd  set  back  rather  than  help 
carry  forward  tlie  plans  and  purposes  which  the  bill  contemplates.  I  believe  it  is 
a  lop-sided  program. 

Mr.  Websteh.  But  do  you  think  the  activities  of  the  Children's  Bureau  in  respect 
of  Btudjang  the  diseases  of  children,  and  making  investigations  of  child  life  among  the 
people  "and  tlie  causes  of  infant  mortality  should  be  transferred  to  the  Public  Health 
Service? 

Dr.  LuMSDEN.  The  Public  Health  Service  is  already  studjT^ng  infant  hygiene  and 
infant  mortality.  The  gentleman  from  Missouri,  Mr.  Hawes,  this  morning  gave  an 
example  in  his  home  State  of  what  is  being  done. 

Mr.  Webster.  You  think  that  is  the  logical  place  for  it  to  be  done,  because  it  is 
professionally  medical;  but  why  stop  there;  why  should  not  the  Public  Health  Service 
carry  on  these  other  acti^'ities? 

Dr.  LuMSDEN.  It  should,  in  my  humble  opinion  carry  on  all  the  public  health 
activities  of  the  Federal  Government  but  Congress  saw  fit,  in  1912,  to  create  an  other 
agency. 

The  Chairman'.  We  know  that.  Doctor. 

Dr.  LuMSDEX.  It  is  not  within  my  province  to  criticize  the  acts  of  Congress,  and  I 
hope  the  questions  asked  me  will  not  compel  me  to  do  so.  ' 

Mr.  Webster.  That  would  be  inconsistent,  if  we  committed  the  work  of  the 
Sheppard-Towner  bill  to  the  Public  Health  Ser\'ice,  instead  of  committing  it  to  the 
Children's  Bureau  to  carry  out  all  of  the  work. 

Dr.  LuMSDEN.  It  might  be  inconsistent,  and  I  think  it  would  be  unfortunate  to 
give  this  bill,  in  its  present  form,  to  any  bureau. 

Mr.  Hawes.  Judge  Webster,  a  moment  ago  I  understand  the  language  read  then, 
with  reference  to  public  health  and  hygiene  work  of  the  Children's  Bureau  was  lim- 
ited to  an  investigation;  that  was  the  limit  on  their  work  as  it  related  to  health.  Now, 
Doctor,  how  much  farther  do  you  go  than  the  mere  investigation  in  your  department? 

Dr.  LuMSDEX.  We  cooperate,  demonstrate,  and  educate. 

Mr.  Hawes.  You  go  right  into  the  work  of  health  itself? 

Dr.  Lumsdex.  Yes,  sir. 

Mr.  Hawes.  You  prescribe  remedies? 

Dr.  Lumsdex.  Xo  medicinal  individual  remedies 

Mr.  Hawes.  I  do  not  mean  individual  remedies,  but  health  remedies? 

Dr.  Lumsdex.  Yes;  we  send  out  thousands  of  publications  giving  advice  to  the 
people  how  to  do  this,  that,  and  the  other  to  keep  well. 

Mr.  Hawes.  If  your  method  of  investigation  and  application  applied  to  sanitation. 
it  would  be  about  25  or  So  per  cent  investigation,  and  65  or  75  per  cent  application? 

Dr.  Lumsdex.  Yes.  in  the  demonstration  rural  health  work  in  order  to  demon- 
strate what  is  meant  by  public  health 

The  Chairmax  (interposing).  We  must  conclude  this  examination,  gentlemen. 

Mr.  Webster.  Here  is  the  reading  of  the  statute  creating  the  bureau: 

"The  said  l)ureau  shall  inveatigate  and  report  to  said  department  upon  all  matters 
pertinent  to  the  welfare  of  children  and  child  life  among  all  classes  of  our  people, 
and  shall  especially  investigate  the  questions  of  infant  mortality,  the  birth  rate, 
orphanage,  juvenile  courts,  desertion,  dangerous  occupations,  accidents  and  diseases 
of  children,  employment  legislation  affecting  children  in  the  several  States  and 
Territories. ' ' 


228  PUBLIC   PROTECTIOlSr    OF   MATERNITY  AliTD   INFANCY. 

Then  follows  a  provision  that  the  Secretary  of  Labor  is  hereby  directed  to  furnish 
sufficient  quarters  for  the  work  of  the  bureau,  and  a  provision  that  the  chief  of  the 
biureau  may  issue  such  pamphlets  from  time  to  time,  as  may  be  prescribed  by  the 
Secretary  of  Commerce  and  Labor.  What  does  the  department  of  public  health  do 
other  than  to  issue  pamphlets  of  its  investigations? 

Mr.  Hawes.  That  is  what  I  asked  the  doctor.  The  Children's  Bureau  is  limited 
to  investigation  and  the  issuing  of  pamphlets  as  the  result  of  investigations.  The 
Public  Health  Service  goes  much  farther.  It  investigates,  and  then  applies  the  rem- 
edy. That  is  the  distinction  between  the  two,  and  it  seems  to  me  it  is  a  very  marked 
distinction.  It  does  not  go  into  a  camp  center,  investigate  and  write  a  report  for  a 
bulletin;  the  Public  Health  Service  camps  writes  a  report,  but  also  helps  to  clear  up  a 
situation  where  there  is  a  condition  that  needs  righting. 

Dr.  LuMSDEN.  And  tries  to  leave  with  the  local  authorities  the  impression  that 
continued  investment  for  local  health  service  is  wise  after  we  have  gone  away  and 
have  been  forgotten  about. 

Mr.  HuDDLESTON.  As  I  understand,  the  functions  of  the  Public  Health  Service 
are  confined  by  the  general  law  simply  to  "investigating  the  diseases  of  man?" 

Dr.  LuMSDEN.  The  general  law  of  1912;  yes,  sir. 

Mr.  HuDDLESTON.  And  there  is  an  appropriation  carried  from  time  to  time,  not 
under  any  general  statute,  which  authorizes  matters  of  report  and  sanitation? 

Dr.  LuMSDEN.  Yes,  sir;  in  sundry  civil  bills. 

Mr.  HuDDLESTON.  Those  two  things  comprise  all  the  authority  that  the  Public 
Health  Service  has? 

Dr.  LuMSDEN.  I  should  not  like  to  answer  that  question  without  a  qualification. 

Mr.  HuDDLESTON.  I  would  like  for  you  to  study  the  matter  up  and  put  it  in  the 
record;  you  will  have  an  opportunity  to  do  so. 

Dr.  LxJMSDEN.  I  shall  be  glad  to  submit  a  memorandum  in  answer  to  your  question. 

(The  following  memorandiun  was  submitted  later  on  by  Dr.  Lumsden  for  insertion 
in  the  record.) 

"Under  the  act  of  February  15,  1893  (ch.  114,  27  Stat.  L.,  449),  the  Public  Health 
Service  (the  then  Marine  Hospital  Service),  is  authorized  under  the  direction  of  the 
Secretary  of  the  Treasury  to  'cooperate  with  and  aid  State  and  municipal  boards  of 
health  in  the  execution  and  enforcement  of  the  rules  and  regulations  of  such  boards 
and  in  the  execution  and  enforcement  of  the  rules  and  regulations  made  by  the 
Secretary  of  the  Treasury  to  prevent  the  introduction  of  contagious  or  infectious 
diseases  into  the  United  States  from  foreign  countries,  and  into  one  State  or  Territory 
or  the  District  of  Columbia  from  another  State  or  Territory  or  the  District  of  Columbia.' 
As  infants  and  prospective  mothers  constitute  a  part  of  the  population  of  the  average 
community  and  like  other  groups  in  the  population  are  subject  to  quarantinable 
and  other  diseases,  it  seems  that  the  Public  Health  Service  under  this  authorization 
has  a  right  to  cooperate  with  State  and  local  health  authorities  in  carrying  out  reason- 
able measures  for  the  protection  of  all  age-sex  groups  in  the  population  against  disease. 
The  venereal  diseases  and  other  communicable  diseases  constitute  a  large  factor  in 
infant  and  puerperal  mortality  and  measures  for  the  promotion  of  the  general  health 
of  infants  and  mothers  gives  them  a  considerable  degree  of  protection  against  com- 
municable disease. 

"The  act  of  August  14,  1912  (ch.  288,  37  Stat.  L.,  309),  authoiizes  the  Public  Health 
Service  to  '  study  and  investigate  the  diseases  of  man  and  conditions  influencing  the 
propagation  and  spread  thereof. '  The  cooperative  demonstration  work  of  the  Public 
Health  Service  in  rural  sanitation  has  a  distinct  investigative  phase.  The  investi- 
gative part  of  the  work  can  not  be  conducted  practically  without  doing  some  educa- 
tional work  which  results  in  measures  being  carried  out  by  individuals,  local  organi- 
zations, and  local  and  State  governments  for  the  protection  of  human  health. 

"In  each  of  the  last  several  sundry  civil  bills  an  item  of  appropriation  has  been 
carried  for  the  rural  sanitation  work  of  the  Public  Health  Service.  The  language  of 
this  item  in  the  sundry  civil  bill  making  appropriations  for  the  cmrent  fiscal  year  is 
as  follows: 

"'Rural  sanitation:  For  special  studies  of,  and  demonstration  work  in  riual  sani- 
tation, including  personal  services,  and  including  not  to  exceed  $5,000  for  the  pur- 
chase, maintenance,  repair,  and  operation  of  motor-propelled  passenger-carrying 
vehicles,  $50,000:  Provided,  That  no  part  of  this  appropriation  shall  be  available  for 
demonstration  work  in  rural  sanitation  in  any  community  unless  the  State,  county, 
or  municipality  in  which  the  community  is  located  agrees  to  pay  one-half  the  expense 
of  such  demonstration  work. ' 

"The  money  appropriated  in  this  item  is  expended  so  as  to  assist  in  the  establish-  -j 
ment  and  maintenance  of  local  health  service  in  rural  districts.  The  local  health  ' 
organization  carrjdng  out  the  work  is  appointed  by  the  proper  local  authorities  and 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  229 

serves  as  a  local  county  or  district  health  orf>;anization.  Such  local  health  departmont 
under  its  local  authority  carries  out  as  a  nde  a  !i:eiioral  y)rof!:ram  of  health  work,  includinp; 
measures  for  the  detection  and  control  of  communicable  disease  and  for  the  promotion 
of  health.  It  conducts  special  investifjations  to  determine  the  modes  of  spread  and  the 
cause  of  prevalence  of  various  disease's  and  to  determine  imf)roved  methods  for  the 
prevention  of  disease  and  the  ]iromotion  of  health.  The  local  health  officer  in  such  a 
demonstration  unit  reports  to  the  Bureau  of  tlie  Pul)lic  Health  Service  in  Washington 
the  actual  or  tlireatened  occurrence  of  communicable  (quarantinabloj  disease  within 
his  jurisdiction  and  within  the  vicinity  thereof." 

Mr.  Lea.  \\'ould  you  jilace  the  information  in  the  record  showing  how  many  States 
are  at  the  present  lime  s])ending  funds  for  the  purposes  pi'oposed  lay  this  bill,  which 
would  qualify  them  for  the  Federal  aid  which  this  bill  provides;  is  that  information 
available? 

Dr.  LuMSDEN.  I  could  ])ut  in  the  jiumber  of  States  that  have  child-hygiene 
divisions;  I  could  not  give  the  details  without  considerable  correspondence. 

Mr.  Lea.  That  would  be  helpful.     You  will  put  in  the  other  information? 

Dr.  LuMSDEN.  I  shall  try  to  do  so. 

The  (•HAimiA.v.  You  waive  the  matter  of  the  approval  of  the  act,  by  sufficient  appro- 
priations? 

Mr.  Lea.  Yes. 

Dr.  LuMSDEM.  You  want  to  know  how  many  States  have  child-hygiene  divisions? 

Mr.  Lea.  Yes. 

Dr.  LuMSDEN.  I  shall  be  glad  to  put  that  in. 

(The  following  memorandum  was  submitted  later  by  Dr.  Lumsden  for  insertion  in 
the  record :) 

INFORMATION    RELATIVE    TO    THE    STATUS    OF    CHILD     HYGIENE    DIVISIONS    IN    STATES. 

States  in  which  there  is  a  child  hygiene  division  in  State  board  of  health:  Alabama, 
Arizona,  California,  Connecticut,  Florida,  Georgia,  Illinois,  Indiana,  Kansas,  Ken- 
tucky, Louisiana,  Maine,  Massachusetts,  Michigan,  Minnesota,  Mississippi,  Missouri, 
Montana,  New  Jersey,  New  Mexico,  New  York,  North  Carolina,  North  Dakota,  Ohio, 
Oregon,  Pennsylvania,  Rhode  Island,  South  Carolina,  Texas,  Virginia,  West  Virginia, 
Wisconsin. 

States  in  which  there  is  no  child  hygiene  division  in  State  board  of  health,  but  in 
which  this  work  is  carried  on  outside:  Colorado,  Delaware  (reconstruction),  Nebraska, 
New  Hampshire,  Utah,  New  Mexico  (2). 

States  in  wliich  no  provision  is  made  for  child  hygiene  work:  Arkansas,  District  of 
Columbia,  Idaho,  Iowa,  Maryland,  Nevada,  Oklahoma,  South  Dakota,  Tennessee, 
Vermont,  Wasliington,  Wyoming. 

Dr.  Lumsden.  Mr.  Chairman,  there  were  about  two  minutes  taken  out  of  my  time, 
and  I  should  like  to  have  a  few  seconds  to  say  one  more  thing. 

The  Chairman.  You  must  make  it  very  brief. 

Dr.  Lumsden.  It  is  about  economy.  One  of  the  most  important  witnesses  before 
the  committee.  Dr.  Josephine  Baker,  discussed  this  matter  from  a  field  standpoint; 
it  was  based  on  experience  in  New  York  City.  Her  division  is  a  part  of  the  health 
department  of  the  city  of  New  York.  The  significant  statement  she  made  was  that 
they  are  spending  through  her  division  to  carry  out  one  of  the  branches  of  the  work 
of  the  health  department  $900,000  a  year  to  give  that  service • 

The  Chairman  (interposing).  I  shall  have  to  ask  you  to  stop,  Doctor;  you  are  not 
stating  anything  new. 

Dr.  Lumsden.  I  wish  only  to  say  that  if  you  apply  that  rate  of  expenditure  to  the 
nation,  it  will  cost  to  administer  this 

The  Chairman.  You  may  put  those  figures  in.  We  are  much  obliged  to  you  for 
your  statement.  Doctor. 


230 


PUBLIC   PEOTECTIOIN"    OF   MATERNITY  AjSTD   IKFAjSTCY. 


(The  statement  referred  to  by  Dr.  Lumsden  follows:) 

Cooperative  rural  health  work  of  Public  Health  Service  in  the  fiscal  year  1921 — sums 
made  available  from,  all  sources  for  the  support  of  the  cooperative  work. 

[Work  performed  in  37  counties  distributed  in  14  States.] 


County  and  State. 

PubUc 
Health 
Service. 

State. 

County. 

.  Munici- 
palities. 

Red 
Cross. 

I.  H.  B. 

Local 
civic  asso- 
ciations. 

Total. 

$2,500 

2,000 

900 

$5,750 
5,000 
5,000 
3,500 
4, 500 
6,000 

17,000 
4,800 

$2,875 
2,380 

$1,800 

$12, 925 

Talladega,  Ala 

Walker,  Ala 

9,380 
5,900 

1,175 

1,500 

300 

275 
2,000 

5,666 

9,675 

Walker,  Ga 

6,000 
12,300 
17,275 

6,800 
15, 164 

Muscogee,  Ga 

6,000 

1 

1 

Clarke,  Ga 

Harrison,  Miss  . 

1,200 
1,250 
1,250 
1,250 
1,250 
2,000 
1,000 
1,000 

2,500 
5,000 
1,000 
1,000 
1,000 
1,000 

2,500 

375 

9,180 

2,764 
7,200 

11,220 

8,450 

Ottawa,  Okla 

4,000 
5,000 
3,000 
3,000 
5,000 
4,600 

'! 

6,250 

1 

6,250 

4,250 

Mason,  Ky 

$2,000 
1,000 
1,000 

3,300 

1,000 

$2,003 
1,000 
1,000 

10,000 

5,000 

2,500 
2,100 

2,700 

15,500 

Edgecombe,  N .  C 

Eighth  Sanitary  Dis- 
trict, Vt 

9,700 
13,200 

$4,700 

11,000 
8,500 
8,800 
7,000 
9,000 

27,000 

9,500 

Santa  Fe,  N.  Mex 

5,800 

8,000 

San  Miguel,  N.  Mex.. 
Cape    Cod    district, 
Mass. 

10,000 

5,100 
9,000 

7,600 

Dubuque,  Iowa 

13  counties  in  Virginia. 

9,375 

60,000 

69,180 

44,405 

67,300 

126,414 

47,575 

9, 100 

4,000 

4,700 

314,474 

PubUc  Health  Service  furnishes  a  little  more  than  13  per  cent,  or  slightly  less  than  one-seventh. 


Dr.  Lumsden.  If  it  costs  $900,000  a  year  to  give  reasonably  adequate  service  for 
the  promotion  of  the  hygiene  of  infancy  and  maternity  among  the  several  millions 
of  population  in  a  closely  built-up  urban  district  like  New  York  City,  it  would  cost 
at  least  $30,000,000  a  year  to  extend  comparable  ser\T.ce  over  this  whole  country  with 
its  extensive  rural  districts. 

The  Chairman.  We  will  hear  Miss  Robertson. 

STATEMENT  OF  MISS  ALICE  M.  ROBERTSON,  A  REPRESENTATIVE 
IN  CONGRESS  FROM  THE  STATE  OF  OKLAHOMA. 

Miss  Robertson.  Mr.  Chairman  and  gentlemen  of  the  committee,  if  I  had  been 
called  on  to  speak  yesterday  morning  I  could  have  done  it  very  bravely  and  fear- 
lessly, thinking  that  perhaps  I  might  have  given  you  some  assistance.  I  have  been 
studying.  You  see  before  you  what  has  prevented  practically  everything  in  recrea- 
tion and  everything  social  on  my  part,  because  I  have  been  going  through  so  much 
of  that  trying  to  leam  about  it  [referring  to  a  large  number  of  books,  magazines,  and 
papers  on  the  table].  Last  night,  before  writing  a  speech,  I  began  trying  to 
find  out  a  little  about  those  who  are  to  decide  as  to  the  presentation  of  this  matter 
through  the  Congress  in  Washington  to  the  people  of  the  country.  I  started  with 
the  Senators,  and  I  have  the  report  of  their  hearings.  I  did  not  get  this  report  until 
yesterday.  I  burned  the  midnight  electricity  reading  them,  and  I  am  a  very  rapid 
reader.     It  was  the  first  opportunity  I  had  to  find  out  about  them. 

From  the  Congressional  Directory  I  find — 

First,  there  is  Mr.  Kenyon,  of  Iowa,  a  lawyer;  he  lives  in  a  nonregistration  State, 
and  therefore  represents  a  nonregistration  State  having  2,404,021  people;  second,  is 
Mr.  Borah,  of  Idaho,  also  a  lawyer,  living  in  a  nonregistration  State,  representing 
431,866  people;  third  is  Mr.  Sterling,  of  South  Dakota,  also  a  lawyer,  representing 
636,547  people  in  a  nonregistration  State;  fourth  is  Mr.  Warren,  of  Wyoming,  a  dealer 
in  live  stock  and  real  estate,  a  nonregistration  State,  representing  194,402  people; 
fifth  is  Mr.  Phipps,  of  Colorado,  a  lawyer,  living  in  a  nonregistration  State,  represent- 
ing 939,629  people;  sixth  is  Mr.  Kellogg,  of  Minnesota,  also  a  lawyer,  representing 


PUBLIC   PROTECTIOlSr   OF   MATERNITY  AND   INFANCY,  231 

2,387,125  people  in  a  registration  State;  seventh  is  Mr.  Shortridge,  of  California,  a  law- 
yer, representing  3,426,861  people  in  a  registration  area;  eighth  is  Mr.  Jones,  of  New 
Mexico,  a  lawyer,  representing  360,350  people  in  a  nonregistration  area;  next  is  Mr. 
McKellar,  of  Tennessee,  a  lawyer,  ropresentin":  2,337,885  people  in  a  nonregistration 
area;  next  Mr.  Wolcott,  of  Delaware,  also  a  lawyer.  lie  has  since  gone,  but  I  put 
his  name  in  just  the  same.  lie  was  representing  233,003  people  in  a  nonregistration 
area;  then  Mr.  Walsh,  of  Massachusetts,  a  lawyer,  representing  3,852,356  people  in 
a  registration  area.  So  that  the  Senate  represents  17,204,045  people  of  the  jjopulation 
out  of  105,000,000  i)eoi)le  in  the  United  States. 

Mr.  ILvuKLKv.  You  mean  tlie  Senate  committee? 

Miss  RoHEHT.soN.  The  Senate  committee;  yes,  sir;  and  you  have  noticed  with  the 
map  before  you  the  States  and  the  people  represented  by  them. 

Now,  I  come  a  little  nearer  really,  I  believe,  and  I  will  try  to  read  more  rapidly. 
There  is  Mr.  Winslow,  of  Massachusetts,  a  manufacturer,  who  represents  3,852,356 
people  in  a  registration  area;  next  is  Mr.  Parker,  of  New  York,  a  farmer,  who  rep- 
resents 10,385,227  people  in  a  registration  State;  Mr.  Sweet,  of  Iowa,  a  lawyer,  who 
represents  2,404,021  people  in  a  nonregistral ion  State;  Mr.  Stiness,  of  Rhode  Island, 
a  lawyer,  who  re]>re8onts  604,397  peoples  in  a  registration  State;  Mr.  Cooper,  of  r)hio, 
a  railway  man,  who  has  been  a  railroad  engineer  on  one  of  the  greatest  railroads  of 
the  country,  who  represents  5,759,394  people  in  a  registration  State;  Mr.  Denison, 
of  Illinois,  a  lawyer,  who  represents  6,485,280  people  in  a  nonregistration  State; 
Mr.  Sanders,  of  Indiana,  a  lawyer,  who  represents  2,930,390  people  in  a  registration 
district;  Mr.  Merritt,  of  Connecticut,  a  manufacturer  and  banker,  who  represents 
1,380,631  people  in  a  registration  State;  Mr.  Webster,  of  Washington — if  this  is  tire- 
some to  the  committee,  I  can  put  it  in. 

The  Chairman.  Go  right  on. 

!Miss  Robertson.  Next  is  Mr.  Webster,  of  Washington,  a  registration  State,  a 
Jawyer,  who  represents  1,356,621  people;  next  is  Mr.  Jonee,  of  Pennsylvania,  a  lawyer, 
who  represents  8,720,017  people  in  a  registration  State;  next  is  Mr.  Mapes,  of  Michi- 
gan, another  lawyer,  who  represents  3,668,412  people  in  a  registration  State;  rfext 
is  Mr.  Graham,  of  Illinois,  another  lawyer,  and  I  will  not  repeat  the  figures  from 
Illinois,  because  he  is  from  the  same  State  as  Mr.  Denison,  which  is  the  one  State 
that  has  two  representatives  on  this  committee.  Next  is  Mr.  Burroughs,  of  New 
Hampshire,  al,so  a  lawyer,  who  represents  443,083  people  in  a  registration  State; 
next  is  Mr.  Newton,  a  lawyer,  of  Minnesota,  who  represents  2,387,125  people  in  a 
registration  State;  Mr.  Hoch,  of  Kansas,  a  lawyer,  in  a  registration  State,  who  rep- 
resents 1,769,257  people;  Mr.  Barkley,  of  Kentucky,  another  lawyer,  in  a  registra- 
tion State,  who  represents  2,416,630  people;  Mr.  Rayburn,  of  Texas,  a  lawyer,  in 
a  nonregistration  State,  who  represents  4,663,228  people;  Mr.  Huddleston,  of  Ala- 
bama, a  lawyer,  who  represents  2,348,174  people  in  a  nonregistration  State;  Mr. 
Lea.  of  California,  a  lawyer,  who  represents  3,426,861  people  in  a  registration  State; 
Mr.  Johnson,  of  Mississippi,  a  nonregistration  State,  who  represents  1,790,618  people; 
Mr.  Hawes,  of  i\rissouri,  a  nonregistration  State,  who  represents  3,404,055  people. 
The  House  committee  represents  70,195,757  of  the  population.  And  you  notice 
that  4  out  of  the  21  members  of  this  committee  are  not  lawyers;  all  the  rest  are.  In 
the  Senate  one  is  not  a  lawyer;  all  the  rest  are. 

To  say  anything  about  how  that  bill  is  made  up,  or  what  it  is  intended  to  say  or 
do  would,  under  those  circumstances,  be  decidedly  a  work  of  supererogation.  If  so 
many  doctors — legal  doctors — differ  on  it,  what  should  a  mere  woman  say? 

There  is  one  thing  I  must  say  here.  I  have  gone  patiently  through  these  things 
[indicating  printed  hearings].  Senators  sometimes  blunder;  they  may  find  out  they 
blundered  yesterday  in  their  votes.  But  Senator  McKellar,  of  Tennessee,  I  think  he 
is,  made  a  statement  to  which  I  want  to  call  attention.  They  were  talking  about  the 
cost  of  things,  etc.,  and  Senator  McKellar  said: 

"It  is  true  that  the  States  who  are  opposed  to  this  bill  pay  a  large  amount  of  taxes. 
The  State  of  Oklahoma  pays  the  third  largest  income  tax  of  all  the  States  of  the  Union.  " 

They  would  rather  they  did  not  have  to  right  now,  because  the  oil  wells  are  a  lia- 
bility rather  than  an  asset  now,  because  the  oil  is  below  the  cost  of  production.  But 
he  says: 

"It  has  too  many  oil  wells  in  that  State,  and  the  Representatives  from  that  State 
are  thoroughly  committed  to  this  proposition.  " 

I  have  the  honor,  through  an  accident,  perhaps,  to  be  one  of  the  Representatives 
from  that  State.  No  one  ever  asked  me  officially  whether  I  was  in  favor  of  this  bill; 
no  one  in  the  Senate  ever  did  me  the  honor  to  tell  me  they  were  having  hearings  over 
there.  I  never  attended  one  of  them.  I  suppose  I  blundered  in  not  finding  out 
about  them,  but  I  have  been  so  busy  looking  after  home  matters  in  the  House,  I  did 
not  go  over  there.     But  I  knew  nobody  had  ever  asked  me  where  I  stood.     So  I  have 


232  PUBLIC  PROTECTION   OF  MATEENITY  AND  INFANCY. 

taken  the  time  this  morning,  since  seeing  that  statement,  to  try  to  see  what  they  did 
over  there  to  call  upon  the  Representatives  to  find  out  how  they  stood .  I  called  upon 
every  Member  of  the  House  from  Oklahoma,  and  not  one  man  has  said  that  he  stood 
for  or  had  expressed  an  opinion  on  this  bill.  I  did  not  ask  him,  "Do  you  favor  it?  " 
because  I  do  not  think  that  is  quite  fair.  I  simply  said,  "Have  you  made  any  state- 
ment as  to  how  you  stand  on  that  bill?  "  I  did  not  poll  them,  either,  but  every  one 
of  them  said  he  had  not  stated  his  position  upon  it. 

On  the  othe  hand,  while — well,  I  will  be  very  frank  and  say  that  I  think  it  was  a 
very  good  thing  for  me  that  they  tried  to  drive  me.  I  am  a  good  deal  like  a  good  many 
other  women;  you  can  lead  me  anywhere  with  a  stick  of  candy,  but  you  can  not  drive 
me  with  a  big  stick.  And  so,  some  time  ago,  when  one  or  two  men  came  to  me  and  said, 
"If  you  don't  get  behind  this  Sheppard -Towner  bill  and  work  for  it  and  vote  for  it, 
the  women  of  your  district  are  all  going  to  be  against  you.  "  Well,  when  I  came  up 
here  I  told  them  all  that  I  was  going  to  do  my  own  thinking;  I  made  no  promises, 
either  before  or  after  election.  You  know  I  was  an  antisuffragist,  and  the  first  political 
thing  that  ever  came  to  me  was  when,  in  1916, 1  was  the  first  woman  elected  in  the  State 
of  Oklahoma,  in  a  political  convention,  to  go  up  to  the  State  convention.  I  told  them 
to  send  the  man  alternate,  because  I  was  not  in  favor  of  women  holding  office,  and  I 
would  not  go;  and  I  did  not.     But  I  was  vice  president  of  the  State  antisuffage  society. 

We  were  very  busy  during  the  war;  we  women  did  wonderful  work,  and  I  want  to 
tell  you  what  the  motto  of  many  of  us  was  down  there:  "Make  it  do.  "  Whatever  we 
had,  in  order  to  save  money,  we  taxed  ourselves  to  the  utmost  limit,  and  our  motto 
was,  "Make  it  do.  "  And  it  is  astonishing  how  much  you  can  do,  as  when  Moses  and 
Aaron  were  sent  on  their  mission,  and  God  said,  "What  is  that  in  thine  hand?"  It 
was  just  a  rod,  but  it  blossomed,  and  it  bore  wonderful  fruit.  So  with  what  the  women 
has  in  her  hand  she  can  do,  as  we  did  during  the  war.  The  way  the  women  did  that 
work  was,  undoubtedly,  in  my  judgment,  the  reason  why  the  vote  was  given  to  us. 
They  said,  "They  have  shown  an  ability  that  we  did  not  know  they  possessed."  -It  is 
indeed  true,  as  a  speaker  said  here,  that  men  need  to  know  more  about  women;  and, 
on  the  other  hand,  women  need  to  know  more  about  men.  We  did  not  want  things 
that  will  be  taking  us  farther  away  from  each  other. 

My  father — it  is  40  years  since  he  rested  from  his  labors,  and  the  pain  of  it  is  yet 
with  me.  We  who  had  such  fathers,  and  we  who  had  g.uch  mothers,  and  we  who  were 
brought  up  in  the  beautiful  family  life  that  came  with  the  hardship  and  toil  of  the 
pioneer  can  not  forget  it.  Six  years  old  I  was  when  the  oldest  little  brother,  the 
fourth  child,  came  into  our  family.  God  sent  him.  We  thought  it  was  very,  very 
wonderful  that  God  had  taken  just  that  time  to  send  him,  when  mother  was  in  bed 
90  that  little  brother  could  lie  there  on  the  other  side  of  the  bed,  and  she  could  keep 
him  so  nice  and  quiet.  And  then  after  awhile  little  sister  came,  and  then  two  little 
brothers;  all  before  I  was  11  years  old.  And  all  with  the  sweet  faith  of  the  child 
who  believed  that  God  did  it,  and  the  mother  who  taught  us  so  purely,  and  we  who 
were  taught  from  the  very  beginning  how  clean  everything  must  be,  believed  God 
sent  them.  There  was  no  doctor.  The  nearest  physician  was  the  Army  surgeon, 
many  miles  away.  There  were  no  trained  nurses.  But  I  learned  what  mother 
could  eat,  and  how  it  must  be  prepared,  and  with  what  care  of  heat  for  cleanliness 
and  all,  because  we  pioneer  missionary  people  learned  to  do  things.  People  do  not 
believe  that  I  learned  to  read  by  the  word  method  when  I  was  a  little  child.  But 
we  who  went  as  pioneers  learned  to  be  so  largely  self-sufficient. 

And  BO  that  h£is  been  the  work  for  women  to  do.  And  we  were  given  the  vote. 
Many  of  us  did  not  want  it;  most  of  us  probably  did  not  want  it;  did  not  ask  for  it. 
You  know  it  was  the  vote  of  the  men  who  gave  it  to  us  and  the  very  active — I  am 
willing  to  say  it — it  was  a  very  active  minority  that  secured  all  this  wonderful  boon 
to  the  great  rather  impassive — if  we  may  say  so — majority.  The  conservative  women, 
not  perhaps  like  those  women  of  Germany;  of  whom  the  Emperor  said  that  with  them 
it  was  "kitchen,  church,  and  children,"  but  still  the  great  number  of  women  who 
love  the  walls  of  their  home;  to  whom  there  is  no  greater  heaven,  no  greater  light 
that  ever  shone,  thati  that  that  comes  from  a  loving  husband  and  the  eyes  of  a  little 
child  looking  up  to  mother.     God  does  not  give  that  to  all  of  us. 

I  call  myself,  usually,  an  old  maid.  After  father,  who  went  home,  left  me  to  take 
up  the  work  while  I  was  yet  a  girl  in  my  teens,  I  took  up  a  man's  work.  1  have  done 
it.  Many  times  I  might  just  as  well,  just  as  bravely,  perhaps,  have  walked  across 
the  red  hot  iron  that  they  say  used  to  be  the  test  of  a  woman's  purity.  Always  I  have 
done  the  work  of  man;  and  in  my  soul  has  been  the  consciousness  of  right-doing,  but 
when  people  have  said,  "Why  don't  you  want  the  suffrage?"  I  said,  "I  have  done  a 
man's  work;  and  I  have  almost  always — not  always^ — but  almost  always  I  have  had 
a  man's  pay." 

But  I  have  paid  the  price. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  233 

I  went  out  this  morning,  and  that  looked  up  to  me  and  it  challenged  me.  [Exhibit- 
ing picture  of  a  child  on  the  cover  of  a  magazine.]  Just  take  that  and  pass  it  along. 
Was  there  ever  anything  so  appealing,  so  wonderful,  as  a  little  child?  Do  you  wonder, 
then,  that  in  this  first  instance  where  the  women  ask  something  as  women — that  is 
the  hurt — they  make  this  appeal?  They  do  not  say,  "Come  on  men,  let  us  see  al)Out 
getting  this."  They  say,  "We  will  go  as  women,  and  we  will  demand  this."  And 
I  am  sorry  for  that.  We  can  not  do  too  much  for  the  mother;  for  the  mother  with  the 
little  child. 

You  see,  we  are  having  to  go  through  all  these  terrible  things,  and  there  are  some 
terrible  things.  There  is  a  terrible  thing  they  call  "VD,"  or  the  red  plague.  How 
are  you  going  to  handle  that?  Out  in  some  parts  of  our  State  they  have  been  handling 
it  lately  through  investigations.  And  when  I  tell  you  that  in  one  of  those  oil  towns 
in  Oklahoma  they  took  a  survey  of  all  those  who  handled  fruit  and  meat  and  drink  and 
vegetables  and  those  who  served  in  the  restaurants  and  did  the  cooking — as  soon  as 
it  was  known  such  an  investigation  was  to  l)e  made  a  numl>er  of  people  hastily  left 
the  town,  so  they  were  not  included.  But  50  per  cent  of  the  people  handling  food 
were  affected  with  the  red  plague.  That  is  a  question,  and  who  can  handle  that? 
The  great  plil)lic  board  of  health?  We  have  not  a  registration  State  law,  but  my  people 
are  doing  it;  in  my  own  town  we  have  the  women's  activities,  because  we  did  not 
quit  at  the  end  of  t'^e  war,  but  we  have  been  "carrying  on." 

You  know,  I  had  a  dream  long  ago.  Knowing  of  the  sorrows  and  trials  of  the  farmer 
women,  I  dreamed  that  some  time  it  might  be  my  work  to  begin  some  little  work 
among  my  people  down  there  in  Oklahoma,  in  those  cabins  along  the  edges  of  the 
streams  and  on  the  prairies,  scattered  round,  and  oftentimes  with  the  roads  so  bad. 
But,  thank  Heaven,  the  march  of  modern  improvement  is  making  the  life  of  the  farm 
women  so  much  less  isolated,  and,  along  some  lines,  that  it  is  not  necessary  for  her  to 
be  dependent  upon  an  inconsiderate  husband,  l;)ecause  he  wants  the  telephone;  he 
wants  the  good  roads  to  "get  there."  And  so  I  have  a  dream  of  community  centers 
following  the  school.  And  we  are  getting  a  good  deal  of  that  line  of  work.  I  wondered 
whether  there  might  not  be  the  community  laundry.  I  wonder  how  many  of  these 
women  who  died — they  say  the  greatest  number  is  among  the  white  native-born 
women— I  wonder  how  many  of  them  died  because  they  will  not  be  dirty;  they  will 
scrub  and  wash  and  iron  and  do  the  work  that  is  too  heavy  for  them.  And  that  is 
where  the  community  service  could  come  in  with  the  laundry,  and  even  the  pig  kill- 
ing could  be  done  there.  All  these  country  activities  could  be  carried  on,  and  I 
think  the  women  are  going  to  wake  up  and  ask  help  in  this  farm  work,  perhaps  through 
some  of  the  many  already  established  bureaus  of  the  Government  to  do  more  for 
them. 

I  do  not  want  to  make  a  speech.  I  can  not.  It  is  just  simply  that  I  thought  that 
I  should  tell  you,  since  every  one  has  been  asked  who  they  represent,  that  I  would 
like  to  represent  the  daddies,  because  I  have  been  on  very  good  terms  with  them,  as 
well  as  the  women  of  those  classes  that  Abraham  Lincoln  said  God  loved,  because  he 
made  so  many  of  the  common  people.  And  it  has  been  the  joy  of  my  life  to  be  with 
the  common  people  that  God  loved.  And  so  there  are  some  things  that  nobody  ought 
to  try  to  take  away  from  daddy.  May  he  not  have  the  joy  of  thinking  of  that  wonderful 
little  new  life  that  is  coming?  If  he  is  not  a  brute  of  a  man,  of  com'se  he  is  anxious  to 
do  everything  possible.  If  he  is  a  brute  of  a  man,  it  will  take  something  a  good  deal 
more  belligerent,  it  seems  to  me,  than  a  children's  bureau  would  be  to  handle  him. 
I  think  he  ought  to  have  the  police — mounted  police,  if  you  will.  He  should  be  taught. 
He  should  be  made  to  do  his  share. 

But  then  think  of  the  wonderful  thing;  think  of  the  little  child's  arms  around  your 
neck.  We  people  they  call  old  maids,  we  upon  whom  God  has  laid  burdens,  do  you 
think  none  of  us  have  mother  hearts?  During  the  war  I  wrote  the  mothers  many,  many 
letters,  writing  at  night,  when  I  did  not  really  have  time,  but  I  had  many  mothers 
write  back  to  me  from  their  faraway  homes  saying,  "It  is  not  only  those  who  have 
borne  children  who  have  mother  hearts;  there  are  others  who  know." 

And  then  always  we  go  back  to  the  most  perfect  law  system  of  all,  to  Him  who  said 
that  he  setteth  the  solitary  in  families;  that  is  for  us;  to  Him  who  said,  "Thy  Maker 
is  thy  husband;"  thatisforus;  toHim  whosaid,  "Ye  must  become  as  little  children," 
and  set  the  child  in  the  midst  of  them.  The  whole  Bible  is  on  the  family  founda- 
tion— the  father,  mother,  and  little  children  all  together. 

And  so  there  is,  in  one  place,  even  what  Paul  said,  who  is  said  not  to  have  approved 
of  women — who  said  that  women  ought  to  keep  silent  in  public — I  was  raised  that 
way — Paul  said ,  ' '  The  children  thou  hast  given  me. "  There  is  a  little  question  about 
Paul;  it  was  thought  that  he  must  have  been  a  bachelor.  I  don't  know.  He  was 
either  an  old  bachelor  or  unhappily  married,  and  I  do  not  know  which  is  the  worst. 

I  see  that  I  am  talking  all  the  jury  away,  so  I  think  I  shall  have  to  stop.  But  I 
will  tell  you  just  one  thing  in  ending,  that  I  believe  in  constructive  work.     Do  not 


234  PUBLIC   PROTECTION   OP   MATERNITY  AND  INFANCY. 

let  UB  fight  each  other.  One  of  the  strangest  things  to  me  is  how  people  with  the 
same  great  purposes  in  view,  with  the  same  great  hearts  of  love  for  humanity  can 
look  so  cross-eyed  at  each  other.     Let  ue  all  get  together. 

Oh,  I  think  the  sweetest  compliment  that  ever  came  to  me  was  when  one  of  my 
grandchildren — I  have  raised  so  many  girls,  you  know,  and  have  helped  to  make  a 
great  many  layettes,  and  have  felt  the  joy  of  making  little  garments  for  other  people's 
babies.  And  in  one  of  the  last  Red  Cross  movements  where  they  had  a  great  pictiKe 
of  a  mother — the  wonderful  Red  Cross  mother — and  on  it  it  said  "The  Greatest  Mother 
of  Them  All,"  and  there  was  a  little  girl  who  was  the  daughter  of  a  girl  I  had  in  rny 
school  family,  and  she  looked  at  that  and  said,  "No;  that  is  not  right;  that  is  a  mis- 
take; Miss  Alice  is  the  greatest  mother  of  them  all;  my  mother  said  so." 

Now,  then,  with  our  country  so  overburdened  with  taxes — I  sit  at  the  table  daily 
beside  a  member  of  the  Ways  and  Means  Committee,  and  I  see  what  those  people  are 
doing.  Now  they  have  taken  up  a  new  thing,  and  the  question  is  where  to  tax ;  where 
to  get  the  money.  And  do  you  realize  that  every  cent  we  are  spending,  every  cent 
we  are  appropriating  out  of  the  National  Treasury  must  be  raised  by  taxes?  And  some- 
times I  get  impatient  when  I  think  of  the  things  we  could  do  without;  we  could  make 
them  do,  if  we  would.  Of  course,  we  all  take  what  we  can  get  without  paying  for; 
at  least,  most  of  us  do.  I  will  not  speak  for  all.  But  if  we  lay  more  taxes  on  our  peqple, 
are  we  not  going  to  deprive  the  mothers  and  children  of  the  food,  the  housing,  the  com- 
forts they  ought  to  have  which  they  may  not  be  able  to  have  with  the  burden  of  taxa- 
tion continuing  to  increase? 

You  can  say  this  bill  is  so  little.  That  is  what  they  say  about  many  others.  You 
know  the  story  of  the  little  child  in  Holland,  where  the  dikes  hold  back  the  water  for 
the  protection  of  the  country,  and  you  remember  the  story  of  the  little  child,  who  going 
along  one  night  heard  the  trickling  of  the  drops  of  water,  and  he  looked  until  in  the 
moonlight  he  saw  where  down  over  the  dike  the  water  was  beginning  to  come,  and  that 
wonderful  child  put  his  little  finger  in  the  hole  in  the  dike  through  which  the  drops 
were  coming  through  all  the  hours  of  the  night  the  faithful  little  soldier  stayed  there, 
child  that  he  was,  preventing  the  enlarging  of  the  hole.  Had  he  not  done  so,  it  would 
have  grown  larger  and  larger  and  the  dike  would  have  gone.  It  is  for  us  women  to 
put  our  finger  p-'  the  dike,  perhaps,  of  this  particular  bill.  I  say  nothing  about  it 
legally.  Oh,  I  bee  you  who  want  this  shake  your  heads.  We  are  always  willing,  like 
Artemus  Ward,  to  wage  the  war  with  our  wife's  relatives.  To  let  some  one  else  do  the 
saving. 

I  thank  you,  Mr.  Chairman  and  gentlemen. 

The  Chairman.  Does  any  member  of  the  committee  desire  to  ask  Miss  Robertson 
any  question?  [After  a  pause.)  If  not,  we  thank  you  for  your  statement.  Miss  Robert- 
pen. 

The  committee  will  now  stand  on  recess  until  2  o'clock  this  afternoon. 

(Thereupon,  at  1  o'clock  and  5  minutes  p.  m.,  the  committee  stood  on  recess  until  2 
o'clock  of  the  same  day.) 

AFTER   RECESS.  _ 

The  committee  reassembled  at  2  o'clock  p.  m.,  pursuant  to  recess. 
The  Chairman.  Gentlemen,  we  will  come  to  order.     Judge  Towner,  will  you  take 
charge  of  the  time  for  the  afternoon,  please. 

Mr.  Towner.  Mr.  Chairman,  Miss  Lathrop,  whom  I  will  call  to  the  stand  in  just  a 
moment,  has  just  given  me  a  copy  of  a  letter  which  she  has  received  from  the  Secre- 
tary of  Labor,  her  chief,  and  I  desire  to  read  it  into  the  record,  because  I  think  probably 
it  is  a  very  important  matter  to  be  considered  in  these  hearings.  It  is  dated  to-day 
and  reads  as  follows: 

The  Secretary  op  the  Treasury, 

Washington,  July  23,  1921. 
Hon.  James  J.  Davis, 

Secretary  of  Labor,  Washington,  D.  C. 
My  Dear  Mr.  Secretary:  In  view  of  the  conference  held  in  your  office  this  morn- 
ing, at  which  were  present  the  Secretary  of  Labor,  the  Assistant  Secretary  of  the 
Treasury  (acting  for  the  Secretary,  who  is  out  of  the  city),  the  Chief  of  the  Children's 
Bureau,  and  the  Surgeon  General  of  the  Public  Health  Service,  I  am  glad  to  assure 
you  that  there  is  no  objection  on  the  part  of  the  Treasury  Department  to  the  admin- 
istrative features  of  the  Sheppard-Towner  biU  now  before  the  Interstate  and  Foreign 
Commerce  Committee  of  the  House  of  Representatives.  Should  the  bill  be  passed,  the 
Public  Health  Service  will  render  every  assistance  possible  to  the  Children's  Bureau. 
Yours,  with  oreat  respect, 

Edward  Clifford, 

Assistant  Secretary. 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  235 

Mr.  Raybukn.  Who  is  that  letter  signed  by? 

Mr.  Town  Kit.  J5y  Kchvaid  Clifford,  Aspistaiit  Secretary. 

Mr.  Bauki.ky.  Will  you  let  rrie  ask  just  one  question  there?  Is  he  the  Assistant 
Secretary  of  the  Treasury  who  has  charge  of  the  Division  of  the  Public  Health  Service? 

Mr.  Towner.  Yes. 

The  Chairman.  Apropos  of  that  letter,  Jud3:e,  could  you  state  or  find  out  who 
initiated  the  call  for  the  meeting  wliich  was  held? 

Mr.  Towner.  I  do  not  know.     Perhaps  Miss  Lathrop  can  tell. 

The  Chairman.  Perhaps  she  would  ])e  willing  to. 

STATEMENT   OF   MISS   JULIA   C.    LATHROP,    CHIEF   OF  THE    CHIL- 
DREN'S BUREAU,  DEPARTMENT  OF  LABOR. 

Miss  Lathrop.  I  think  the  Secretary  of  Lal)or  talked  with  the  Secretary  of  the 
Treasury  about  the  matter. 

The  Chairman.  On  his  own  initiative? 

Miss  Lathrop.  Well,  none  of  his  inferiors  would  have  any  dictation  to  him.  He 
and  I  talked  over  the  situation.  It  is  a  very  great  misfortune,  the  continued  mis- 
Tinderstanding  between  the  two  biu-eaus,  and  he  thought  that  consultation  might  be 
a  good  thing? 

I  scarcely  know  where  to  begin,  Mr.  Chairman,  and  yet  I  think,  perhaps,  in  the 
interest  of  fair  understanding  I  might  venture  to  correct  certain  statements  which 
indicate  a  lack  either  of  common  sense  or  regard  for  the  amenities  on  the  part  of  the 
<'hildren's  Bureau.  And  first  I  want  to  mention  the  suggestion  of  someone  that  the 
Children's  Bureau  did  not  in\-ite  the  Public  Health  SetAdce  to  participate  in  the 
standards  of  child  welfare  conferences  which  were  held,  at  the  conclusion  of  the  long 
demonstration  and  investigations  of  Children's  Year,  in  May  and  June  of  1919.  As 
the  letter  of  transmittal  of  the  proceedings  states,  the  bureau  in\ated  the  head  of  the 
Public  Health  Ser^-ice,  Dr.  Rupert  Blue,  and  the  Commissioner  of  Education,  Dr. 
■i'laxton,  to  act  with  it  as  a  committee  of  arrangements.  Yor  some  reason,  doubtless 
■an  inadvertence,  we  received  one  reply  from  Dr.  Blue,  and  he  did  not  act. 

However,  I  believe  that  members  of  the  Public  Health  Service  did  attend  the 
eessions,  and  I  know  that  one  of  the  ablest  papers  we  had  was  by  Dr.  Leigh,  of  the 
Public  Health  Service. 

1  wish  to  speak  about  the  charge  of  bolsheidsm,  anarchism,  and  socialism  against 
the  Children's  Bureau,  based  on  the  publication  of  Maternity  Benefit  Svstems  in 
Certain  I'oreign  Countries,  by  Hemy  J.  Harris.  I  think  as  one  connected  with  the 
bureau — and  if  I  may  I  shall  re\'iew  as  briefly  as  possible  the  growth  of  the  bureau — 
but  I  want  to  get  this  out  of  the  way — as  one  connected  with  the  bureau  and  desiring 
to  discover  whether  public  arrangements  for  the  protection  of  maternity  and  infancy 
were  usual  in  the  world  and  were  valuable  to  mothers  and  children,  it  was  plainly 
■our  duty  to  go  to  that  part  of  the  world  where  old  governments  had  for  long  years  had 
such  legal  provisions,  and  Henry  J.  Harris,  who  is  Chief  of  the  Document  Division  of 
the  Library  of  Congress  and  formerly  a  statistical  expert  in  the  Government  8er\'ice, 
was  secured  to  prepare  this  study.  It  is  written  in  what  I  believe  any  candid  and 
intelligent  reader  would  consider  a  scientific  and  impartial  spirit. 

In  the  letter  of  transmittal  I  have  stated  that  the  section  on  Russia  is  now  of  his- 
torical interest  only.  Because  of  various  limitations  in  our  own  force  it  was  not 
possible  for  us  to  puljlish  the  volume  for  between  one  and  two  years  after  it  was  really 
prepared. 

As  to  Madam  KoUontai's  book,  which  has  been  referred  to,  it  was  published  in  1910 
at  Petrograd.  All  that  it  states  as  to  Russia  was  concerning  the  Czar's  Russia  and 
her  own  relation  to  Russia  was  that  of  a  subject  of  the  Czar.  The  book  has  absolutely 
nothing  to  do  with  the  revolution  which  began  in  1917.  Undoubtedly  her  compila- 
tion was  the  most  voluminous  and  perhaps  complete  collection  of  material  extant  at  the 
time  the  bureau  study  was  written.     It  was  properly  included  in  the  bibliography. 

Madame  Kollontai  seems  to  have  traveled  very  largely  and  everywhere  to  have 
gathered  information  on  this  particular  subject  and  to  have  published  it.  Indeed, 
there  was  a  reque-st  that  the  Children's  Bureau  should  republLsh,  but  after  our  trans- 
lators had  looked  at  the  material  it  did  not  seem  advisable  to  undertake  so  costly  a 
piece  of  work,  because  we  could'  in  more  brief  manner  present  all  that  was  necesvsary 
and  from  more  original  sources.  This,  of  course,  was  all  before  the  present  revolu- 
tionary movement. 

Mr.  Newton.  May  I  interrupt  there?  In  the  examination  of  this  matter,  did  you 
read  the  translation  yourself?    That  is,  are  you  familiar  with  the  book  it.self? 

Miss  Lathrop.  Xo.  We  had  a  Russian— the  book  is  in  Ru.ssian;  it  has  not  been 
translated  into  English.  Our  translator  examined  it,  and  it  was  reported  as  a  mass 
of  material  chiefly,  I  think  composed  of  documents. 


236  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

Mr.  Newton.  Does  it  represent  a  sort  of  resume  of  the  various  maternity  benefit 
sj'stems  in  European  countries? 

Miss  Lathrop.  Yes. 

Mr.  Newton.  And  in  it  does  the  author  advocate  the  adoption  of  any  one  or  all  of 
these  systems? 

Miss  Lathrop.  As  I  understood,  it  was  a  mere  compilation  of  material. 

Mr.  Newton.  A  study? 

Miss  Lathrop.  Yes. 

Mr.  Newton.  Is  there  anything  in  it  by  way  of  nationalization  of  children  or 
anything  hinting  along  that  line  at  all? 

Miss  Lathrop.  Well,  I  have  no  reason  to  sui:)pose  that  there  was. 

Mr.  Newton.  You  know  of  no  such? 

(At  this  point  Mr.  Barkley  took  the  chair.'' 

Miss  Lathrop.  I  know  of  no  siich.  I  think  it  would  have  been  sensational  enough 
at  that  time  so  that  any  translator  would  have  reported  it. 

Because  of  the  connection  that  has  been  sought  to  be  made  between  the  maternity 
benefits  of  foreign  countries  and  the  measure  before  this  committee  I  feel  I  ought  tO' 
state  briefly  why  these  maternity  benefits  were  developed. 

Now,  like  a  few  of  our  States,  some  three  or  four  of  the  industrial  States,  in  Europe' 
in  practically  all  the  industrial  countries  work  before  and  after  childbirth  was  and  is 
prohibited,  and  the  moment  that  you  prohibit  a  working  woman  who  has  a  household: 
and  who  has  young  children  from  working,  you  are  undoubtedly  prohibiting  some- 
body who  is  poor  enough,  so  that  her  food  is  going  to  be  lessened  if  she  stops  working,, 
and  there  came  at  once  to  those  people  the  necessity  of  making  some  jDrovision  for- 
this  period,  and  also  for  the  care  which  was  necessary;  and  it  is  of  that  necessity — 
and  indeed  with  an  effort  for  humanity — that  the  provisions  of  the  European  coimtries 
have  been  made.     It  is  a  very  interesting  study. 

We  have  studied  the  different  systems  and  have  differentiated  upon  them,  and  we 
finally  felt  that,  leaving  aside  what  my  personal  opinion  or  any  interest  I  should  say 
was  my  o^vn  belief,  that  the  American  system  ought  not  to  be  one  of  compulsion;  we- 
have  finally  thought  that  the  measure  which  we  are  now  presenting  here  might  be- 
one  which  would  so  stimulate  localities,  so  provide  facilities,  that  we  should  escape- 
the  cumbersome  character  of  these  maternity  benefits  with  their  compulsory  features- 
Mr.  Newton.  May  I  ask  right  there — or  possibly  you  would  rather  answer  it  later — 
I  differentiate  between  the  plan  that  is  set  forth  here  in  this  particular  bill  and  those  of 
the  European  systems,  where  there  is  an  endowment  of  metherhood  or  the  payment 
of  wages.     I  think  there  is  a  great  difference.     Do  you  not  think  so? 

Mis  Lathrop.  We  think  so. 

Mr.  New"ton.  I  would  be  interested  in  getting  your  own  view  in  reference  to  the- 
European  system,  as  to  whether  or  not  you  think  there  is  any  occasion  to  use  that  here- 
in this  country. 

Miss  Lathrop.  I  see  no  reason  at  present.  It  ought  to  be  the  very  last  resort,  in 
my  opinion,  and  it  is,  of  coiu"se,  true,  if  we  may  judge  by  the  varying  experiences  of 
England,  of  Australia,  and  of  New  Zealand,  that  the  cash  allowances  have  not  proved 
wholly  satisfactory.  The  most  brilliant  example  of  a  nation  which  has  protected  the- 
lives  of  infants — I  am  not  talking  now  about  maternity  benefits — that  has  most  effec- 
tively protected  infancy,*  so  that  for  many  years  it  has  the  lowest  infant  death  rate  im 
the  world,  is  one  which  provides  facilities  and  whose  insurance  system  is  so  slight 
that  it  may  be  regarded  as  a  negligible  factor. 

What  has  driven  that  rate  down  year  after  year  and  year  after  year  is  that  the  Gov- 
ernment has  subsidized  this  private  society  for  the  preservation  of  the  health  of 
women  and  children;  that  it  has  furnished  publications  that  the  society  in  turn  has 
had  in  the  press  of  that  country  so  that  the  most  recalcitrant  parent  could  hardly 
dodge  it — steady,  interesting  information  as  to  the  care  and  health  of  young  children, 
and  that  the  society  has  also  kept  trained,  specially  trained,  nurses  in  the  field,  known 
as  the  "Plunkett  nurses,"  and  that  at  present  in  addition  to  all  this  the  State  has  now 
set  up  two  maternity  hospitals,  which  it  does  not  expect  to  be  charity  hospitals  but 
pay  hospitals,  and  that  the  society  has  a  hospital,  just  a  little  country  hospital,  for 
the  care  of  children,  to  which  the  mother  goes  with  the  child  and  learns  with  it,  as 
the  child  is  treated,  how  to  care  for  the  child.  There  is  great  nicety  and  skill  and  of 
course  some  expense  about  these  provisions,  but  there  is  no  hint  either  of  pauperizing 
or  of  money  benefit. 

One  of  the  distinguished  officials  of  New  Zealand  was  here  not  long  ago  and  was 
asked  about  the  Plunkett  muses,  and  he  said,  'I  think  very  highly  of  those  nurses, 
as  their  field  muses  are  called.  My  grandson  prospered  greatly  under  them."  The 
New  Zealand  educational  service  is  available  for  all. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  237 

Now,  in  view  of  the  suggestion  of  duplication,  I  have  thought  that  I  might  briefly 
set  forth  the  principles  wliich  govern  the  Children 'h  Bureau,  and  which,  perhaps,  as 
I  said  before,  will  ex])lain  the  a])parent  duplication. 

»■  ]The  bureau  wa-s  created  in  1912  to  investigate  and  report  upon  all  matters  pertain- 
ing to  the  welfare  of  children  and  child  life  among  all  classes  of  our  people.  It  was 
created  at  a  lime  when  there  had  been  for  y(;ars  a  Hureau  of  Education  in  the  Depart- 
ment of  the  Interior,  and  for  years  a  Public  Health  Service  under  the  Treasury,  bear- 
the  same  h-gal  rclatioji  to  the  Treasury  that  the  Children's  Bureau  bears  to  the  Depart- 
ment of  Labor.  I  take  it  that  the  long  campaign  for  the  creation  of  the  Children's 
liureau,  a  l>ureau  to  investigate  and  report  upon  all  matters  pertaining  to  the  welfare 
of  children,  reveals  an  almost  unconscious  jjublic  ijclief  that  the  child  can  not  be 
parceled  out  among  the  sciencies,  that  the  interest  of  child  welfare  involve  many 
sciences,  and  that  somehow  the  social  field  inust  be  covered  by  a  recognition  of  all 
these  activities  and  by  a  wise  and  intelligent  cooperation  with  special  kinds  of  science, 
like  education  and  medicine. 

When  I  came  into  the  Children's  Bureau  I  realized  the  breadth  of  the  bureau's 
•charter  and  the  existence  of  these  older  services,  and  I  early  called  upon  the  com- 
missioner of  education  and  the  head  of  the  Puljlic  Health  Service,  to  invite  aid  and 
cooperation. 

From  time  to  time  I  advised  with  the  Public  Ib^alth  Service  and  I  submitted  the 
plan  for  the  Ijureau's  first  (ield  study — that  into  infant  mortality — to  the  then  head 
of  the  Pul)lic  Health  Ser\ice,  wiio  said — I  think  I  can  almost  remember  exactly  his 
words — "The  plan  is  new.  It  has  not  been  tried.  The  result  would  be  valuable, 
and  we  do  not  expect  to  undertake  it." 

We  therefore  began  the  series  of  studies  of  infant  mortality  not  yet  concluded,  which 
discuss  the  social,  economic,  civic,  and  family  factors  surrounding  children  in  the 
first  year  of  life.  We  remembered  all  the  time  as  we  went  from  house  to  house  that 
the  law  forbids  any  agent  of  the  bureau  to  enter  any  house  against  the  will  of  the 
person  who  is  at  the  head  of  the  family,  and  while  we  have  visited  some  24,000 
mothers  in  the  course  of  that  inquiry,  I  think  we  had  14  refusals  to  give  information. 
It  was  a  touching  and  important  fact  that  we  were  welcome.  These  mothers  of  every 
social  cla.'^s,  because  we  have  no  rule  except  that  every  mother  of  every  baby  born 
in  a  given  town  in  a  given  year  is  visited,  said  they  were  glad  that  the  Government 
was  trying  to  find  out  how  to  help  save  the  life  of  the  children,  and  they  wanted  to 
help  in  any  way  they  could. 

1  believe  the  idea  that  there  will  be  resentment  throughout  the  country  if  this  bill 
becomes  law  is  entirely  unfounded.  I  am  sure  other  services,  like  the  Bureau  of 
Education  and  the  Public  Health  Service,  have  eaxctly  the  same  experiences  as  the 
Children's  Bureau  has,  that  the  people  of  the  country  intelligently  desire  that  the 
Government  shall  gather  and  distribute  information  on  topics  which  are  of  practical 
importance,  and  such  the  welfare  of  children  certainly  is. 

Nothing  that  the  Children's  Bureau  has  published  has  been  so  popular  as  those 
pamphlets  addressed  to  the  individual  mother.  We  have  never  been  able  to  supply 
the  demand. 

In  view  of  the  reference  yesterday  to  the  pamphlet  i3u])lished  by  the  Public  Health 
Service  entitled  "Care  of  the  Baby,"  I  will  explain  how  duplication  of  pamphlets 
between  the  Children's  Bureau  and  the  Public  Health  Service  has  come  about.  The 
(Jhildren's  Bureau  submitted  its  manuscript  on  child  care  to  the  Public  Health 
Service,  which  had  then  no  publication  of  the  same  character.  Earlier  the  Children's 
Bureau  had  been  offered  a  small  pamphlet  on  the  care  of  the  baby,  ^vritten  by  a  group 
of  podiatrists,  but  the  then  chief  clerk  of  the  Department  of  Commerce  and  Labor 
decided  that  the  Children's  Bureau  could  not  accept  this  pamphlet  and  publish  it 
under  the  rules  of  the  department.  Therefore  the  bureau  prepared  a  pamphlet  of  its 
own. 

Later,  after  our  pamphlet  was  in  type,  I  learned  that  this  care  of  the  baby  pamphlet 
had  been  taken  by  the  Public  Health  Service  and  had  been  published  by  it  without 
consulting  the  bureau  although  by  that  time  we  had  a  new  chief  clerk  who  construed 
the  law  differently,  and  we  could  have  taken  it.  Plainly  there  was  no  duplication  on 
the  bureau's  part.  Other  instances  of  more  serious  nature  might  be  noted,  but  I 
would  much  rather  dwell  on  the  cooperation  which  has  been  possible  between  the 
Public  Health  Service  and  the  Children's  Bureau  than  upon  any  duplication  which, 
however  ill  advised,  has  never  begun  to  serve  the  country  as  it  served  to  be  served. 
We  have  had  repeated  opportunities  on  studies  to  cooperate  with  them  in.  In  one 
study  the  Public  Health  Service  furnished,  for  instance,  a  physician  to  make  the 
mental  examination  while  the  bureau  made  the  social  study  that  we  made  for  the 
State  of  Delaware,  in  cooperation  not  only  with  the  Public  Health  Service  but  also 
^vith  the  Bureau  of  Education,  upon  an  inquiry  made  at  the  request  of  the  officials  of 
Delaware . 


238  PUBLIC   PEOTECTIOI^    OF   MATERNITY  AND   INFANCY. 

In  another  case  the  bureau  furnished  a  special  agent  for  a  war  study  of  the  delin- 
quent girl  by  the  Public  Health  Service.  Other  pieces  of  cooperation  could  be 
mentioned . 

I  think  the  most  important  point  at  present  in  connection  with  this  bill  is  the 
question  of  whether  there  is  a  kind  of  cooperation  between  these  bureaus  in  the  Gov- 
ernment which  is  scientific,  effective,  and  economical,  or  whether  it  is  better  for  us 
all  to  go  our  separate  ways.  I  am  satisfied  by  the  experience  of  the  Children 's  Bureau 
that  we  can  not  go  our  separate  ways  without  steadily  encroaching  upon  each  other's 
fields.  While  we  had  no  doctor  at  first  on  the  staff  of  the  bureau  and  therefore  were- 
forced  to  make  a  social  and  eocnomic  stldy  of  infant  mortality,  revealing  as  it  did 
that  ugly  coincidence  of  low  income  and  high  infant  mortality  rates,  we  were  eager  to- 
have  the  correction  and  the  advice  of  medical  persons,  and  when  our  bureau  was  first 
enlarged  we  at  once  set  up  a  Division  of  Child  Hygiene,  not  only  because  we  wished 
that  division  to  make  studies,  but  because  we  wished  to  have  at  hand  a  physician 
whose  advice  upon  studies  in  the  indistrial  and  in  the  social  fields  was  immediately 
available. 

I  am  sure  that  there  might  be  methods  of  cooperation  evolved.  I  believe  that  the- 
letter  which  has  been  read  indicates  the  beginning  of  coordinated  activities  which  will 
take  away  from  all  of  us  the  reproach  under  which  we  seem  to  lie,  of  having  failed  to^- 
make  the  most  of  each  other 's  highly  specialized  facilities. 

I  wish  to  say  one  more  word  about  doctors.  It  has  been  indicated  that  the  Children 's 
Bureau  was  a  bureau  not  able  to  understand  the  value  of  the  medical  profession.  Of 
course  that  is  very  far  from  true.  We  have  been  fortunate  enough  to  have  not  only  a 
medical  staff  for  the  last  seven  years,  but  we  have  the  advice  and  aid  of  many  of  the- 
most  distinguished  men  in  the  country. 

I  would  like  to  pay  a  tribute  to  a  man  who  has  never  been  publicly  mentioned  in 
connection  with  Government  work  to  my  knowledge.  One  of  the  first  and  most 
difficult  things  the  bureau  has  attempted  was  its  pamphlet  on  pre-natal  care.  This 
is  practically  a  resume  of  a  book  by  Dr.  John  Slemmons,  a  distinguished  authority 
in  that  field.  He  most  generously  gave  the  gist  of  his  new  book  for  the  bureau  publi- 
cation and  advised  Mrs.  Max  West  in  writing  her  compact,  simple  pamphlet.  This 
report  has  met  a  genuine  need  and  has  an  increasing  circulation,  base  entirely  upon 
actual  requests.  No  man  of  science  has  given  a  more  patriotic  contribution  to  the 
Government's  work  for  child  welfare  than  was  given  by  that  piece  of  medical 
cooperation. 

Now,  as  we  go  along,  trying  for  cooperation,  we  find,  as  Mrs.  Putnam  very  eloquently 
pointed  out  yesterday,  that  somehow  the  doctors  are  too  scarce  and  too  precious  to  be- 
used  for  mere  organization;  that  lay  people  must  make  it  possible  for  doctors  and 
nurses  to  do  their  work.  I  think  we  shall  find  also  that  there  is  more  and  more  a 
tendency  to  demand  special  equipment  for  special  pieces  of  work,  even  if  the  specialist 
is  not  found  in  just  the  usual  category.  To  illustrate:  The  head  of  the  English  mis- 
istry  of  health  is  to-day  a  barrister.  Sir  Alfred  Mound,  who  was  chosen  because  in 
England  the  greatest  question  to-day  in  public  health  in  social  decency  and  therefore 
in  child  welfare  is  the  housing  question,  and  he  is  an  acknowledged  authority  on 
housing. 

The  head  of  the  Boston  Dispensary  for  years  has  been  Mr.  Michael  Davis.  From 
his  new  book  called  "Immigrant  Health  and  the  Community,"  I  quote  a  paragraph 
on  "The  cooperation  of  the  layman,"  which  I  might  possibly  read,  though  I  do  not 
know  that  I  ought  to  take  your  time  to  read  this  page  or  two.  It  is  to  the  effect — 
it  discusses  the  subject  on  the  basis  of  the  immigrant  woman  and  the  heavy  death 
rate  of  women  in  child  birth,  which  is  shockingly  large,  as  he  says,  as  compared  to 
that  of  most  other  civilized  countries,  and  it  dwells  on  the  cooperation  which  he 
believes  to  be  necessary  between  the  lay  and  the  professional  persons  in  order  to  give 
the  professional  people  their  chance  to  make  the  most  of  their  costly  education- 
Perhaps  I  would  be  allowed  to  put  it  in  the  record,  if  you  care  to  have  it. 

The  Chairman.  Put  in  what  you  think  is  fair. 

Miss  Lathrop.  I  can  put  in  a  paragraph,  if  that  is  agreeable. 

The  Chairman.  Very  well. 

(The  matter  referred  to  follows:) 

"It  is  well  at  this  point  to  observe  how  little  the  general  American  public  realizes 
that  maternity  care  is  a  problem;  that  in  America,  even  among  the  native  born,  the- 
death  rate  of  women  in  childbirth  or  from  causes  directly  due  to  childbirth  is  shock- 
ingly large  compared  to  that  of  most  other  civilized  countries.     *    *    * 

"The  people  who  do  use  the  midwife,  the  people  who  do  call  in  the  obstetrical 
teaching  service,  are  the  immigrants  and  the  poor;  but  these  have  not  made  known 
their  experience  because  they  rarely  have  access  to  the  channels  of  public  expression.. 
The  specialists  have  conducted  a  discussion,  chiefly  within  their  own  circles.  The 
Federal  Children's  Bureau  has  recently  been  showing  in  its  publications  the  high. 


PUBLIC  PROTECTION   OF   MATERNITY   AND  INFANCY.  239 

rate  of  maternal  naortality  in  the  United  States  and  the  grave  deficiencies  in  service 
to  mothers,  at  confinement,  discovered  in  its  surveys  of  rural  communities  and  of 
towns.  These  facts  are  just  hep:inninp  to  filter  into  lay  journals  and  to  receive  the 
attention  of  public  meetin<^s,  women's  clubs,  and  other  j^roups  wherein  plain  people 
come  tojrether. 

"  It  is  well  that  this  is  beginning  to  be  so,  for  whatever  policy  medical  men,  health 
workers,  nurses,  students,  and  surveyors  may  decide  upon,  in  so  large  a  matter  as 
maternity  care  for  th(>  women  of  this  country  a  program  can  ]h'.  effective  oidy  if  there 
is  a  general  apiircciation  of  the  facts  on  the  part  of  the  i)ul)lic,  a  keen  sense  of  the  needs 
that  must  be  met,  and  an  aroused  discontent  with  conditions  that  nmst  V)e  bettered." 

Miss  Lathkoi".  There  has  l)een  much  talk  al)out  tlie  statistics  involved.  I  have 
ventured  to  prepare,  but  not  ventured  to  lay  upon  your  desk,  a  statement  as  to  the 
figures  on  which  our  own  ta1)ulations  are  made,  as  to  the  risk  rate  of  mothers  and 
infants,  together  with  the  authorities  which  wc  have  consulted.  I  believe  that  it 
is  sound,  and  there  has  been  a  curious  confirmation  in  an  article  by  William  Travis 
Howard,  who  is  a  distinguished  member  of  the  staff  of  Johns  Hopkins,  a  brother-in-law 
of  Dr.  Whitridgc  \\'illiams,  (>ntitled  "The  risk  rate  of  death  to  mothers  from  causes 
connected  with  childbirth."  We  have  never  said  things  as  extreme  as  he  has  said 
as  to  the  unnecessary  loss  of  life  from  that  cause. 

The  rural  question  has  been  somewhat  put  aside  here  on  the  theory  that  the  rural 
rates  seem  to  be  a  little  better  than  the  url)an  rates,  but  serious  questions  are  covered 
by  the  averages  of  rural  and  urban  rates.  It  is  true  that  of  the  22  States  and  the  Dis- 
trict of  Columbia  constituting  the  registration  area,  16  show  rural  areas  more  favorable 
than  the  urban  areas;  but  on  the  whole  the  differences  are  slight,  and  we  begin  to 
wonder  what  is  the  matter  ^^dth  the  country,  because  here  is  that  part  of  our  country 
which  we  always  say  brings  the  vigor  and  strength  to  reinforce  the  greedy  and  exhaust- 
ing cup  of  the  city,  and  it  is  possible  that  it  is  getting  to  be  less  vigorous  than  it  was. 
I  believe  the  truth  is  that  there  are  areas  of  the  country  which  are  extremely  favorable, 
favorable  beyond  anything  the  city  can  offer,  and  other  areas  of  a  singularly  unfavor- 
able type. 

I  have  tried  to  illustrate  this  question  of  rates  in  favorable  and  unfavorable  areas 
by  a  summation  of  material  in  our  infant-mortality  studies,  in  which  we  took  certain 
cities,  Baltimore,  Gary,  Akron,  Saginaw,  Waterbury,  Boston,  New  Bedford,  Man- 
chester, and  Johnstown,  and  we  took  the  rate  for  the  entire  city,  and  then  the  rates 
which  on  the  map  are  the  rates  of  most  congestion,  of  poorest  incomes,  ignorant  indus- 
trial population — and  they  always  seem  to  be  perfectly  separable  out  from  the  rest — 
and  we  took  those  rates  in  those  cities,  unfavorable  districts  as  we  call  them,  and  then 
in  the  favorable  districts,  and  the  favorable  districts  were,  of  course,  those  districts 
where  people  live  where  the  sanitation  was  the  best,  where  the  incomes  were  the  best, 
where  there  was  the  comfortable  life  and  the  openness  of  housing  which  we  get  in  our 
fine  residential  neighborhoods  in  all  but  a  very  few  of  the  most  crowded  cities  and  in 
all  the  rural  areas,  and  there  the  rates  came  down  to  66  in  Baltimore,  to  84  in  Gary, 
to  54  in  Akron,  and  so  on;  whereas  the  rates  in  the  unfavorable  areas  were  more  than 
twice  as  much  in  every  case — not  more  than  twice  as  much  in  one  case,  but  approxi- 
mately that — -very  markedly  greater. 

MEMOEANDUM   CONCERNING   THE    STATISTICS    OF   MATERNAL   MORTALITY. 

The  statistics  of  maternal  mortality  are  compiled  directly  from  oflScial  sources  by 
dividing  the  number  of  deaths  from  all  puerperal  causes  by  the  number  of  live  births. 
They  are  therefore  based  upon  the  best  evidence  that  can  be  secured  upon  this  subject. 
According  to  statistics  based  upon  this  material,  the  United  States  stands  seventeenth 
in  a  list  of  important  countries  for  which  figures  can  be  obtained. 

Figures  for  the  United  States  related  to  the  birth  registration  area  only,  which  in 
1919  included  22  States  and  the  District  of  Columbia,  with  an  estimated  population 
of  58.6  per  cent  of  the  total  population  of  the  United  States. 

The  rate  for  the  United  States  birth  registration  area  was  nearly  20  per  cent  higher 
than  the  next  highest  rate — that  for  Scotland — and  considerably  over  200  per  cent 
higher  than  the  rates  for  Italy,  Norway,  or  Sweden. 

A  slightly  more  accurate  way  of  stating  maternal  mortality  would  be  per  thousand 
confinements  instead  of  per  thousand  live  births.  But  the  number  of  confinements 
is  only  abcut  3  or  4  per  cent  more  than  the  number  of  li^e  births,  and  for  purposes 
of  comparison  between  the  countries  the  number  of  live  births  is  the  most  satisfactory 
basis.  No  figures  showing  the  number  of  confinements  are  available  for  the  United 
States  birth  registration  area  for  1919. 

The  figures  shown  are  in  each  case  the  latest  available  figures  for  the  country  in 
(juestion.     If  figures  were  available  for  each  country  for  1919,  slight  differences  might 


240  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

occur  in  rates  for  certain  of  the  countries.  The  United  States,  however,  has  a  rate 
so  far  above  those  of  other  countries  that  the  position  of  the  United  States  would  not 
be  affected  if  rates  for  1919  were  available  for  all  the  countries. 

In  the  last  analysis  the  accuracy  of  these  statistics  depends  upon  the  completeness 
of  registration  on  the  one  hand  and  the  accuracy  of  certification  of  cause  of  death 
upon  the  other.  On  both  counts  the  figures  of  western  European  countries  are  prob- 
ably better  than  those  of  the  United  States.  Registration  of  births  and  deaths  has 
been  compulsory  for  a  much  longei  period  in  other  countries  than  in  the  United 
States;  for  example,  in  England  since  1870,  in  New  Zealand  since  1855,  while  in  the 
United  States  some  States  still  lack  adequate  registration  laws  or  adequate  enforce- 
ment of  the  laws  they  have.  As  to  the  accuracy  of  certification  of  causes  of  death, 
the  evidence  available  indicates  that  if  the  causes  of  death  were  all  correctly  certified 
in  the  United  States  as  well  as  in  all  other  countries,  the  position  of  the  United  States 
in  regard  to  maternal  mortality  rate  would  still  be  worse  than  that  of  a  number  of 
other  advanced  countries  and  much  worse  than  there  is  any  need  for  it  to  be  if  the 
knowledge  now  available  in  regard  to  prevention  of  these  deaths  were  put  to  effective 
use. 

Maternal  wortality  rates  per  1,000  births. 

[Rates  for  latest  available  year  up  to  ]919.J 

Italy  (1915)  (Annuarie  Statistico  Italiano,  1916) 2.  2 

Norway  (1915)  (Annuaire  International  de  Statistique,  Tome  II,  1917)) 2.  7 

Sweden  (1915)  (Annuaire  Statistique  de  la  Suede,  1919) 2.  9 

The  Netherlands  (1919)  (Annuaire  Statistique  du  Royaume  Pays-Bas,  1919). ..  3.  4 

Prussia  (1914)  (Statistisches  Jahrbuch  fiir  den  Preussischen  Staat,  1915) 3.  5 

Japan  (1916)  (Mouvement  de  la  population  de  1' Empire  du  Japon,  1916) 3.  5 

Finland  (1916)  (Annuaire  Statistique  de  Finlande,  1918) -. 3.  6 

Hungary  (1915)  (Annuaire  International  de  Statistique,  Tome  II,  1917) 4.0 

England  and  Wales  (1919)  (Annual  report  of  the  Registrar-General  of  England 

and  Wales,  1919) 4.  4 

France  (1913)  (Annuaire  International  de  Statistique,  Tome  II,  1917) 4.  6 

Australia  (1918)  (Official  year-l)ook  of  the  Commonwealth  of  Australia,  1919). .  4.  7 

Ireland  (1918)  (Annual  report  of  the  Registrar-General  of  Ireland,  1918) 4.  8 

New  Zealand  (1919)  (Statistics  of  the  Dominion  of  New  Zealand,  1919,  Vol.  1) . .  5. 1 

Spain  (1915)  (Anuario  Estadistico  de  Espana,  1917) 5.  2 

Switzerland  (1915)  (Annuaire  Statistique  de  la  Suisse,  1916) 5.  5 

Scotland  (1919)  (Annual  report  of  the  Registrar-General  for  Scotland,  1919) 6.  2 

United  States  (Birth  Registration  Area)  (1919)  (United  States  Birth  Statistics, 

1919,  and  Mortality  Statistics,  1919) 7.  4 

The  bureau  has  been  asked  to  go  into  some  of  these  extreme  rural  areas.  We  did 
go  to  some  of  them,  into  what  is  left  of  the  extreme  western  homesteading  area  of  the 
United  States,  and  it  was  very  clear  after  we  had  made  a  few  studies  that  the  reports 
that  had  come  to  us  were  not  exaggerated.  The  bureau's  rural  study  shows  areas 
where  native  intelligent  people  are  so  isolated  and  cut  off,  in  the  slow  development  of 
the  country,  that  they  can  not  get  unaided  the  care  which  the  mothers  need,  while 
world  settlements  of  immigrants  often  remain  even  more  lonely  and  apart.  Hence,  if 
we  are  going  to  give  all  the  children  of  the  country  a  fair  chance,  we  must  not  be  satis- 
fied with  rural  rates  a  little  better  than  urban  rates,  but  must  realize  that  there  are 
areas  where  much  can  be  done  to  bring  the  rural  rate  down  to  rates  which  we  can 
not  yet  imagine — perhaps  we  can  not  get  down  to  where  New  Zealand  is,  but  perhaps 
at  any  rate  we  can  bring  all  of  our  States  down  to  where  our  most  favorable  areas  are. 

Now,  it  is  to  undertake  to  do  some  of  this  equalizing  work  by  the  means  with  which 
you  are  all  familiar  in  that  bill  that  this  bill  has  been  created  and  the  Children's 
Bureau  has  come  along  to  the  drafting  of  that  bill,  not,  I  think,  because  necessarily 
that  would  have  been  the  thing  that  we  would  do,  but  because  after  we  had  worked 
for  years  seeing  yearly  coming  up  to  us  more  and  more  a  conclusive  proof  that  mothers 
and  children  were  dying  needlessly  in  this  country,  more  and  more  a  conviction  that 
we  ought  to  try  to  get  some  means  which  could  be  dignified  as  the  school  and  yet  not 
burdensome  financially,  that  we  finally  felt  it  was  as  undignified  for  the  bureau  not  to 
try  to  study  out  some  method  of  dealing  with  the  question  as  it  would  be  if  we  did  not 
make  the  original  studies,  and  so  we  have  submitted  this  plan.  Whether  it  is  the 
best  plan  we  do  not  know.  I  believe  that  there  are  features  in  it  which  make  it  a 
plan  which  will  enlist  great  public  interest.  I  believe  it  is  a  plan  which  mil  enlist 
enought  public  interest  so  that  gradually  communities  will  provide  and  control 
locally  those  facilities  which  are  absolutely  necessary,  if  mothers'  lives  and  children's 
lives  are  to  be  saved. 


PUBLIC  PROTECTION   OF   MATERNITY   AND  INFANCY.  241 

And  a1)ovc  all  I  IjoUovo  that  it  does,  or  will  do,  what  it  is  fortainly  intended  to  do  ; 
that  it  will  stiinulato  the  uu'dical  i)rofes.sion ;  that  it  will  stinndate  the  nursing  pro- 
fession; that  the  ijopular  understan{lin<.>-  in  this  country  of  what  a  fine  jjhysician  means 
in  this  field,  of  what  adetjuate  nursinp;  means  in  this  field,  is  the  first  step  towards 
jjetting  out  medical  schools,  our  nurses  training  schools,  properly  financed  to  educate 
the  young  people  who  can  and  will  do  this  work.  And  if  these  young  men  and  young 
women  see  there  is  a  field,  one  of  honor  and  opywrtunity.  we  shall  not  lack,  as  we 
have  l)een  told  in  this  hearing  we  lack  at  jtresent,  un  ade(iuate  numl)er  of  candidates 
either  in  our  medical  schools  or  in  our  schools  of  nursiuir. 

The  part  that  the  Children's  Bureau  has  to  ])lay  in  this  is  a  very  small  jiart. 

There  has  been  a  great  deal  said  here  aliout  the  fact  that  the  l)ureau  might  destroy 
any  plan  of  any  State.  J  do  not  know  whether  any  legislation  coidd  be  good  for  any- 
thing if  it  were  so  tight  that  it  left  nothing  to  the  discretion  of  the  ]ieople  who  were 
to  administer  it,  es|)ecially  if  it  were  in  a  field  like  this,  in  which  we  have  48  States 
with  different  Tiee<ls,  different  constitutions,  different  organizations,  different  oppor- 
tunities for  work,  different  classes  of  popidation. 

The  reason  that  this  bill  was  left  as  it  was,  alter  stating  very  succinctly  the  limits  of 
the  type  of  education  and  demonstration  that  should  be  given,  was  fjecause  of  the 
wide  differences  in  the  needs  of  the  48  States.  It  seemed  imperative  that  there 
should  be  the  greatest  elasticity  in  allo^^^ng  the  States  to  proceed  in  the  way  which 
was  locally  deemed  wisest. 

1  think  that  is  all  I  care  to  .say.  Mr.  Chairman. 

The  Chairman.  Does  any  member  of  the  Committee  desire  to  ask  Miss  Lathrop 
any  questions? 

Mr.  Denison'.  ^fr.  Chairman,  T  did  want  to  ask  one  or  two  questions,  but  I  gotin  too 
late  to  hear  !Miss  Lathrop's  remarks,  and  I  do  not  know  whether  you  have  covered  the 
])oints  T  want  or  not.  But  I  will  take  the  chance  of  asking  you  this  qiiestion,  whether 
or  not  you  believe.  Miss  Lathrop,  in  the  principle  of  maternity  benefits  as  it  is  exem- 
plified in  foreign  countries? 

Miss  Lathrop.  I  have  answered  that  question  at  length,  Mr.  Denison,  and  I  tried  to 
say  that  I  xevv  much  deprecated  the  compulsory  features,  and  that  I  agree  with  those 
who  feel  that  "compidsion  in  not  consonant  with  American  ways  of  doing  things.  _  This 
bill  is  offered  as  an  effort  to  provide  a  substitute  more  consonant  with  American  ideas. 

Mr.  Denisont.  I  was  not  interested  in  the  compulsory  featiire  of  it  at  all,  but  I 
was  wondering  if  yon  were  in  favor  of  what  I — — 

Miss  Lathrop  (interposing).  Cash  benefits? 
•  Mr.  Dexisox.  What  I  call  "maternity  benefits;"  that  is,  the  Government  providing 
some  kind  of  maternity  benefits  for  the  mothers. 

Miss  Lathrop.  Yon  "mean  the  Federal  Government,  or  any  government? 

Mr.  Denisox.  I  vnll  limit  this  question  to  the  Federal  Government,  yes. 

Miss  Lathrop.  Do  I  approve,  or  advocate  the  Federal  Government  proAdding  actual 
physical  care  for  motherhood? 

Mr.  Dexisox.  Well,  in  some  coimtries  it  takes  the  form  of  governmental  contri- 
bution of  money  to  the  mother  during  the  period  of  child  bearing. 

Miss  Lathrop.  Yes,  in  England,  a  cash  benefit  is  provided  under  the  compulsory 
insiu'ance  act.  In  Australia  a  sum  is  given  outright  on  the  birth  of  a  living  child. 
I  am  not  in  favor  of  either  plan  here. 

Mr.  Denison.  In  other  coxmtries  it  takes  the  form  of  wages;  in  other  countries  it 
may  take  some  different  form,  but  in  some  form  or  another,  it  is  a  governmental  con- 
tribution to  the  mother  of  financial  aid  during  that  period. 

Miss  Lathrop.  The  bureau  studies  of  infant  mortalitj^  indicate  the  importance  of 
a  man's  getting  wages  enough  to  support  his  wife  and  his  young  children;  and  if  the 
country  h^s  that  it  will  not  have  to  endow  motherhood. 

Mr.  Denison.  Well,  I  woidd  not  class  information  as  maternity  benefit;  I  make 
that  distinction,  and  such  information  as  may  be  conveyed  to  the  women  generally 
under  it,  in  the  form  of  publications  or  in  the  form  of  lectures  or  instructions  that  is 
general  and  applies  to  all  of  the  communities  alike.  I  do  not  call  that  a  maternity 
benefit;  but  what  I  refer  to  as  a  maternity  benefit  is  a  contribution  of  a  financial 
nature  to  particular  or  individual  mothers  during  that  period.  Now,  what  I  want  to 
know  is,  do  yon  indorse  that  principle  or  are  you  opposed  to  it? 

Miss  Lathrop.  I  am  opposed  to  it,  because  I  am  in  favor  of  getting  the  income  up 
to  a  level  where  it  will  not  be  necessary.  The  reason  they  had  it  in  Europe  was 
because  they  were  so  terribly  poor. 

Mr.  Denisox.  Yes,  but  suppose  that  income  does  not  get  to  the  point  where  mothers 
will  not  need  financial  aid.  Under  those  circumstances — and  I  am  assuming  that 
that  condition  always  has  existed  and  always  will  exist,  because  the  poor  we  will 
always  have  with  us'  and  there  will  always  be  poor  people  who  can  not  afford  nurses , 

74654—21 16 


242  PUBLIC   PROTECTION   OF   MATERNITY   AND   INFANCY. 

and  in  some  instances  might  not  be  able  to  afford  physicians — that  is  a  condition  which 
exists  in  all  coimtries,  always  has  existed,  and  always  will.  Now,  then,  assuming 
that  that  condition  will  continue  to  exist,  do  you  think  that  the  Government  ought 
to  step  in  and  attempt  to  equalize  those  conditions  to  some  extent,  at  least  to  the 
extent  of  some  sort  of  governmental  aid  in  a  financial  way  to  the  mothers  under  those 
conditions? 

Miss  Lathrop.  I  have  never  thought  of  it  just  in  that  way.  Of  course,  you  know 
what  does  happen  in  our  States,  that  when  people  are  absolutely  poverty  stricken 
they  go  to  our  poorhouses  and  they  get  awfully  bad  care,  and  generally  it  is  a  costly 
and  poor  way  for  the  community,  judged  by  human  results. 

Mr.  Denison.  But  the  ordinary — as  I  understand  it,  the  ordinary  way,  the  usual 
way  that  those  problems  are  met  now  in  this  country,  is  through  some  form  of  volun- 
tary contribution  or  charitable  organization  which  for  humanitarian  reasons,  out  of 
public  spirit,  is  generally  on  the  lookout  for  distressing  cases,  and  we  generally  get 
aid  to  them  through  voluntary  contributions  or  through  local  organizations.  Now  I 
know  we  are  all  in  favor  of  that  wherever  there  is  need,  but  that  is  a  different  principle 
entirely  from  that  aid  being  furnished  by  the  Government  through  a  system  of  taxation, 
and  I  was  wanting  to  know — interested  in  knowing  from  you,  because  there  are  some 
who  are  favoring  this  bill  and  have  been  promoting  it  who  do  believe  in  the  so-called 
"maternity  benefits" — and  I  was  wanting  to  know  whether  anyone  connected  with 
the  Government  has  those  views  or  believes  in  that  principle. 

Miss  Lathrop.  Personally,  I  have  never  advocated,  and  see  no  reason  to,  and  the 
bureau  has  certainly  never  even  discussed  the  matter.  I  can  say  further  that  I 
think  the  history  of  those  cash  benefits  shows  a  good  deal  of  ineffectiveness.  Usually 
they  are  offered  instead  of  the  facilities  which  the  person  really  needs,  and  they  do 
not  bring  the  facilities  any  closer  to  the  person. 

Mr.  Denison.  Well,  perhaps  the  question  I  asked  was  prompted  by  the  statement 
in  the  pamphlet  which  the  bureau  issued,  which  after  reviewing  these  various  systems 
of  maternity  benefits  in  other  countries,  made  the  remark  that  the  work  done  in  these 
countries  is  "impressive?"  Now  that  was  the  language  used  by  the  pamphlet — ■ 
"impressive" — and  I  was  wondering  whether  that  carried  with  it  any  sort  of  indorse- 
ment or  recommendation  of  those  systems. 

Miss  Lathrop.  It  was  not  intended  as  an  indorsement.  It  calls  attention  to  a 
remarkable  fact.     I  am  speaking  for  myself  now  and  not  for  the  bureau. 

Mr.  Denison.  I  would  like  you  to  speak  for  yourself  and  speak  for  your  associates 
in  the  bureau  if  you  can. 

Miss  Lathrop.  I  do  not  know  that  I  can,  always.  But  speaking  for  myself,  I 
should  say  that  this  bill  is  a  protest  against  this  stage  of  American  civilization,  forcing 
back  our  industrial  population  into  the  proneness  which  those  continental  methods 
were  created  to  aid.  It  was  said  here  yesterday  by  somebody,  as  if  we  were  advocating 
it,  that  there  was  a  provision  in  old  Russia,  under  the  Czar,  that  there  should  be  a 
midwife  wherever  there  were  100  women.  Now,  the  old  method  of  factory  labor 
was  a  living-in,  as  we  say,  the  work  people  lived  within  the  factory.  There  was, 
practically  a  colony  of  workers  living  under  control  of  the  factory,  and  the  provision 
came  from  that.  I  do  not  know  whether  this  fact  is  of  interest,  but  it  shows  a  standard 
of  life  which  is  alien  to  us,  and  explains  a  matter  which  was  referred  to  by  a  witness. 

Mr.  Denison.  I  have  noticed  in  some  publications  here  in  this  country,  pubhcations 
that  are  issued  by  parties  who  are  urging  this  legislation,  statements  to  the  effect  that 
the  time  is  soon  coming  and  ought  to  be  hurried  when  the  Government  will  pay  the 
wages  to  the  mother  during  the  period  of  childbearing. 

Miss  Lathrop.  Mr.  Denison,  you  did  not  see  that  in  anything  the  bureau  has 
published. 

Mr.  Denison.  No;  I  was  saying  it  is  by  publications  issued  by  those  who  are  urging 
most  forcefully  this  legislation,  and  that  is  what  prompted  me  to  ask  the  question 
of  you,  because  I  want  to  know,  and  I  am  sure  the  other  members  of  the  committee 
do  also,  whether  or  not  the  Children's  Bureau  indorses  to  any  extent  such  a  principle 
as  that. 

Miss  Lathrop.  I  do  not  know  the  publications  to  which  you  refer.  As  far  as  I 
know  or  represent  the  bureau,  it  does  not  support  this  doctrine;  and  if  friends  do  it, 
sometimes  friends  are  almost  more  dangerous  than  enemies. 

Mr.  Denison.  I  think  in  this  case  they  are.     It  has  been  proven  so. 

Miss  Lathrop.  You  can  not  be  responsible  for  that. 

Mr.  Denison.  No;  I  know  that. 

Mr.  Newton.  Miss  Lathrop,  something  further  along  the  line  that  Mr.  Denison  has 
been  following: 

Is  this  Miss  Todd — I  think  it  is  Miss  Helen  Todd — did  she  ever  have  anything  to 
do  with  the  bureau? 

Miss  Lathrop.  In  no  wav. 


PUBLIC  PROTECTION   OF.  MATERNITY   AND  INFANCY.  243 

Mr.  Newtom.  Hor  name  waa  rofoired  1o  by  scimo  one  here  as  ehairman  of  Horne 
birth-control  lea<^iie,  I  believe,  and  I  notice  extracts  from  some  of  her  sajnngs  that 
are  extremely  radical.  Has  she  ever  in  any  way  been  consulted  in  connection  with 
the  policy  of  the  bureau. 

Miss  Latiiijoi'.  She  has  not,  so  far  as  I  know. 

Mr.  Nkw  ro.N'.  Or  did  anyone  ever  claim  with  any  possi])le  show  of  reason  at  all, 
that  she  in  any  way  has  been  conferred  with  in  reference  to  the  policy  of  the  bureau? 

Miss  Latiikoi'.  I  think  nobody  except  th(!  witness  yesterday. 

Mr.  Nkwto.v.  I  notice  the  statement  here  taken  from  the  "\Voman  Patriot,"  under 
the  headinf;  "The  family,"  which  says: 

"Way  back  in  19l()l)r!  x\nna  Howard  Shaw,  thenpresidentof  the  National  American 
Woman's  SulTraj^e  Association,  declare<l:  'I  woidd  like  to  make  motherhood  af^overn- 
raental  institution.  I  would  pension  all  mothers  and  have  them  provided  for 
first  to  last  by  the  State.  I  believe  that  motherhood  should  be  indejjendent  of  any 
man.' "' 

Now  it  is  rather  hard  to  follow  her  reasoninj^. 

Miss  Lathrop.  I  don't  think  it  is  veiy  fair,  do  you,  to  take  a  sentence  which  may 
or  may  not  ha\-e  been  said  by  one  of  the  noblest  and  sanest  jtatriots  this  country  ever 
had.  and  offer  it  in  a  context  which  makes  it  absurd? 

Mr.  Newton.  I  don't  know,  but  it  is  pretty  hard  for  me  to  rec:oncile  that  even  with 
or  without  the  context. 

Mi.ss  Lathuoi'.  1  don't  believe  that  she  ever  said  it  in  any  sense  in  which  it  was 
eouirht  to  ])e  shown  there.     I  should  want  to  be  shown. 

Mr.  Newton.  I  hope  she  never  said  it. 

Now,  here  is  an  extract  from  Miss  Alice  Paul,  whom  we  have  heard  more  or  le.ss  of 
here  in  Washini^ton.  It  puryjorts  to  be  a  statement  of  hers  in  the  Washington  Herald, 
Oc toiler  25,  ]f)20,  and  it  sounds  as  if  this  might  be  true: 

"We  intend  to  insist  al.'-o  that  the  State  assume  entire  responsibility  for  the  main- 
tenance and  education  of  children  until  they  become  of  age.  When  the  women  of 
the  world  have  junked  the  battle.'^hips  and  other  impedimenta  of  war,  enough  money 
will  be  relea?-ed  to  take  care  of  the^-e  reforms." 

Miss  Lathrop.  Well,  she  did  not  include  the  Children's  Bureau  in  that  editorial, 
did  she?     [Laughter.] 

Mr.  Newton.  No.  Here  is  still  another  one,  by  Mrs.  Harriet  Stanton  Blatch, 
daughter  of  Eliza1)eth  (-'ady  Stanton: 

"Every  woman,  whether  the  wife  of  a  millionaire  or  a  day  laborer,  will  in  the  world 
builded  by  women,  be  made  to  feel  that  society  honors  motherhood  sufficiently  to 
place  it  above  all  sordid  considerations." 

There  are  several  more  such  extracts  from  women  who  have  been  more  or  less 
prominent  of  late  in  connection  with  the  change  that  has  brought  al)0ut  suffrage. 
Now  there  is  a  well-grounded  fear  among  lots  of  people  who  believe  that  the  State — 
and  V)y  the  State  I  mean  in  its  broad  sense — ought  to  do  more  than  it  has  been  doing  for 
the  mother  and  for  the  child,  but  who  fear  that  some  of  those  who  are  advocating  such 
extreme  measures  of  this  kind,  that  are  so  distasteful,  that  are  so  foreign  to  our  way  of 
looking  at  things,  that  the  adoption  of  a  measure  of  this  kind  will  be  sort  of  commencing 
a  program  such  as  is  indicated  by  the  statements  that  I  have  quoted. 

Miss  Lathrop.  May  I  say  that  personally  I  think  that  is  a  small  group.  None  of 
them  chance  to  be,  \vith  the  exception  of  Anna  Howard. Shaw,  whom  I  think  we 
should  eliminate,  among  those  who  have  been  supporters  or  counselors  of  the  Ijureau, 
and  I  believe  that  any  such  dread  is  ill-founded. 

Mr.  Newton.  I  take  it  then  that  outside  of  Dr.  Shaw  none  of  these  have  in  any 
way,  shape,  or  form,  directly  or  indirectly,  been  advisers  of  the  bureau  or  anyone  in 
the  bureau  having  anything  to  do  with  shaping  the  policy  of  the  bureau? 

Miss  Lathrop.  No,  I  think  that  is  entirely  true. 

Mr.  Newton.  Now  I  have  interrupted  you.     Please  go  ahead  vnih  your  statement. 

Miss  Lathrop.  No;  I  just  wanted  to  say,  going  back  again  to  this  social  aspect  of 
this  matter,  that  the  reason  that  we  have  got  to  have  this  cooperation  is  not  to  get  the 
Government  to  do  things  for  the  family.  It  is  to  create  a  family  that  can  do  things 
for  itself;  it  is  to  get  parents  who  know  what  their  children  need,  who  are  good  and 
■wise  and  can  secure  a  decent  living;  who  know  when  they  need  a  doctor  and  will 
have  him;  who  wall  know  when  they  need  pulilic  health  and  -v^-ill  help  to  pay  for  it 
gladly,  and  who  know  what  kind  of  a  school  they  want  their  children  to  go  to,  and 
will  help  to  create  that  and  pay  for  that. 

The  whole  question  of  society,  it  seems  to  me,  is  involved,  and  whether  we  want  a 
society  which  magnifies  the  family  and  makes  the  family  more  and  more  responsible 
for  it  elf  as  a  unit,  instead  of  putting  on  outside  activities,  to  take  any  share  of  that 
responsibility  away. 


244  PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY. 

Mr.  HocH.  Miss  Lathrop,  we  all  recognize,  I  take  it,  that  the  problems  of  mother- 
hood and  of  childhood  are,  as  you  have  said,  and  others  have  said,  sociological  and 
economical  and  medical ;  but  is  it  not  true  that  as  far  as  this  particular  bill  is  concerned 
it  is  directed  to  that  feature  of  the  problem,  the  welfare  of  mothers  and  children,  which 
is  essentially  medical?  It  provides  in  the  opening  paragraph  that  this  money  is  for 
the  purpose  of  cooperating  with  the  States  in  promoting  the  care  of  maternity  and 
infancy,  to  provide  instruction  in  the  hygiene  of  maternity  and  infancy. 

Miss  Lathrop.  Now,  that  is  to  provide  instruction  by  qualified  persons,  originally 
and  undoubtedly  chiefly  doctors,  and  under  them  by  nurses,  and  then  by  teachers 
and  by  social  workers.  There  are  very  well  qualified  people  who  are  not  physicians, 
in  the  public-health  field.  The  head  of  one  of  the  great  public-health  schools  in  this 
country,  Yale,  is  not  a  doctor. 

Mr.  HocH.  Yes;  so  that  we  recognize  that  this  bill  is  for  the  purpose  of  fm-nishing 
particularly  and  essentially  medical  health — that  is,  I  use  the  word  "medical "in  the 
very  broad  sense — the  care  of  the  body,  essentially. 

Miss  Lathrop.  Yes. 

Mr.  HocH.  The  care  of  expectant  mothers,  prenatal  care,  and  of  the  child,  par- 
ticularly the  very  young  child;  and  for  that  reason  the  administration  of  this  fund  is 
vested  in  the  State  boards  of  health.     That  is  true,  is  it  not? 

Miss  Lathrop.  Yes. 

Mr.  HocH.  That,  therefore,  seems  a  plain  recognition  all  the  way  through  the  bill 
that  the  piu'pose  is  medical,  so  far  as  this  bill  is  concerned,  not  that  the  others  are  not 
equally  important  or  possibly  of  greater  importance,  and  your  bureau  has  a  large  work 
to  do  in  those  other  fields,  but  this  bill  is  essentially  medical.  That  being  true,  what 
objection  is  there  to  providing  that  the  supervision,  as  far  as  the  Federal  Government 
is  concerned,  of  this  fund  shall  be  in  the  hands  of  a  board  which  is  more  essentially  a 
medical  board  than  your  bm'eau  is? 

Miss  Lathrop.  The  feeling  of  those  who  believe  that  the  administration  will  be 
most  productive  of  results  in  the  Children's  Bureau  is  that  the  Children's  Bureau 
has  already  a  very  wide  acquaintance  throughout  the  country  with  people  who  are 
acquainted  with  it  and  accustomed  to  cooperate  -wdth  it,  and  it  will  be  easier  for  it 
to  secure  the  sort  of  popular  good  will  and  understanding  that  would  help  to  increase 
the  local  facilities  than  if  it  were  a  purely  medical  measure.  Perhaps  we  are  mistaken. 
At  no  point  is  the  use  of  compulsion  contemplated,  but  it  is  provided  in  the  bill  that 
the  State  boards  may  have  advisory  committees  of  men  and  women,  both  State  and 
local,  hoping  that  with  cooperative  activities  of  that  kind  whatever  the  localities 
need  will  be  locally  furnished  and  controlled.  Now  you  can  not  go  into  any  locality 
without  finding  that  there  are  economic  and  social  factors  which  are  also  involved. 
I  think  that  has  never  been  quite  so  well  set  out  in  my  hearing  or  reading  as  it  was  by 
Miss  Fox  at  the  preAdoiis  hearing  before  this  committee — and  I  regret  that  Miss  Fox 
had  to  leave  town  before  there  was  an  opportimity  for  her  to  speak.  She  pointed 
out  how  the  nurse  herself  found  that  the  problems  which  must  be  met  before  nursing 
care  or  medical  care  could  be  made  effective  were  largely  social  and  economic  and 
family  problems. 

Mr.  HocH.  I  can  well  understand,  as  far  as  the  independent  work  of  your  bureau 
is  concerned,  that  it  involves  that  cooperation  with  the  various  persons  and  organiza- 
tions witliin  the  State;  but  as  far  as  this  bill  is  concerned,  wherein  would  your  bm-eau 
have  any  cooperation  of  which  you  speak,  aside  from  the  cooperation  with  the  State 
agencies,  which  are  the  State  boards  of  healththat  are  to  administer  the  fund  provided 
for  in  tliis  bill? 

Miss  Lathrop.  Of  course  there  is  opportunity  for  great  voluntary  cooperation.  I 
also  feel  that  it  would  be  unfortunate  if  this  bill,  with  all  its  connections,  social  and 
educational,  its  special  rural  bearing,  and  the  connection  with  the  Bureau  of  Educa- 
tion, which  as  work  developed  I  think  would  be  quite  as  close  as  with  the  Public 
Health  Service — that  it  would  be  unfortunate  to  have  it  all  absorbed  under  a  medical 
head,  just  as  I  think  it  would  be  unfortunate  to  have  it  all  absorbed  under  the  Bureau 
of  Eduaction.  Both  bureaus  have  felt  earlier — perhaps  they  were  right — that  the 
Children's  Biu-eau  vdth  all  its  facilities  should  have  been  put  under  one  or  the  other; 
but  I  believe  that  the  separate  social  activity  which  does  secure  cooperation  of  both 
medicine  and  teaching,  and  of  a  large  social  field  besides,  will  get  the  largest  public 
effect  and  response. 

( At  this  point  Mr.  Barkley  took  the  chair.) 

Mr.  HocH.  You  have  spoken  with  reference  to  the  advantage  which  would  exist 
in  having  this  work  in  your  bureau  by  virtue  of  the  fact  that  you  have  established  in 
the  past  connections  with  organizations  and  persons  in  the  States,  and  have  a  starting 
point.  Now,  under  the  same  reasoning  might  we  not  say  that  inasmuch  as  this  fund 
is  to  be  administered  through  the  State  boards  of  health,  that  the  Federal  Board  of 


PUBLIC   PROTECTIOlSr   OF   MATERNITY  AND  INFANCY.  245 

Health  would  have  tliat  advanta,c;e  by  virtiio  of  (lie  fact  tliat  it  iiad  estaldislied  very 
close  relatioiiH  witli  these  State  boards  of  liealth,  who  are  tlio  cooperative  aj^ency, 
so  far  as  this  l)ill  is  concerned?  They  have  cooperation  wliicli  your  bureau  has  not 
had . 

Miss  Latiirop.  And  perhaps  that  is  true,  ])ut  of  course  wo  would  like  to  give  them 
a  little  social  leaven,  so  to  speak. 

Mr.  Ilocn.  Well,  wherein  is  tliat  social  leaven  provided  for  in  tins  bill?  I  am  in 
hearty  sympathy  willi  that  sficial  leaven  of  which  you  speak.  l)Ut  we  are  talking  now 
about  a  particular  bill.  Wherein  is  that  provided  for  in  the  fund,  which  of  course  is 
the  heart  of  this  bill,  the  appropriation  of  money  to  the  States  to  be  used  by  the  States 
imder  a  plan  whicli  has  the  approval  of  a  Federal  agency?  That  is  the  heart  of  this 
bill,  as  1  understand  it. 

Miss  Latiiuop.  Now,  we  state  that  that  care  can  not  l)e  given  solely  as  a  matter  of 
medicine,  nor  even  as  a  matter  of  public  health;  but  that  it  must  enlist  other  interests 
in  the  country;  first,  becaui^e  it  is  not  entirely  medical;  and  secondly,  because  there 
must  be  more  money  provided  for  medical  and  lun-sing  care  in  many  of  our  communi- 
ties than  is  possible  to  get  from  public  sources,  and  that  must  depend  on  the  good 
will  of  the  society  of  the  various  communities,  just  as  has  l^een  pointed  out  in  the 
extract  from  Davis's  liook. 

Mr.  Hocrf.  Now,  if  your  surmise  is  correct — and  there  is  much  force  in  it  as  it 
appeals  to  me — doesn't  the  1)111  then  fall  down  in  the  very  essential  regard,  in  that 
when  it  comes  to  administer  the  fund  which  is  part  of  the  proposition,  you  provide 
for  administering  it  through  a  medical  board,  a  State  board  of  health? 

Miss  Lathkop.  No,  I  think  not,  Mr.  Hoch.  You  see  all  these  child-hygiene  divi- 
sions, with  the  exception  of  eight,  came  into  existence  following  and  probal)ly  because 
of  the  publicity  and  the  general  interest  which  was  created  ))y  children's  year,  the 
second  year  that  we  were  in  the  war.  There  are  now  38  of  them.  Dr.  Rudd,  director 
of  the  bureau's  Child  Hygiene  Division,  is  in  constant  correspondence  with  them.  I 
ought  to  add  that  the  l)ureau  has  done  much  work  for  years  at  the  request  of  State 
boards  of  health  and  in  cooperation  with  them.  We  have  not  had  money  enough 
to  do  what  the  Public  Health  Service  has  gone  in  and  done  very  handsomely,  but 
we  have  a  natural  and  intimate  connection  with  what  might  be  called  "socialized 
medicine-"  through  the  State  boards  of  health. 

Mr.  Hoch.  AN'hat  reason  have  you  to  expect  that  State  boards  of  health  in  the 
administration  of  this  fund  will  be  any  more  alert  to  the  social  and  economic  a.spects 
of  the  problem  than  the  Federal  Board  of  Health  would  be  in  approving  the  nlans 
that  would  be  carried  out  Ijy  the  State  boards  of  health? 

Miss  Lathrop.  Some  of  them — I  do  not  know  that  they  would  be  any  more  effective 
than  the  Federal  boards — ))ut  some  of  them  have  already  made  many  connections, 
secured  much  help  fi'om  the  bureau,  and  are  very  cordially  disposed  toward  the 
bureau.  I  think  they  have  a  feeling  of  the  value  of  the  bureau  as  a  social  agency, 
which  is  reflected  in  a  resolution  of  the  State  and  Provincial  health  authorities  that 
has  been  submitted  for  insertion  in  the  record,  indicating  that  they  desire  to  see 
the  administration  lodged  in  the  Cliildren's  Bureau. 

Mr.  Hoch.  I  do  not  want  to  force  you  into  a  position  where  you  might  be  embar- 
rassed by  any  criticism  of  another  agency  of  the  Government,  but  this  is  a  matter  of 
very  great  interest  to  me  in  connection  with  this  bill,  and  you  may  answer  this  or  not: 

Do  you  fear  that  a  Federal  board  of  health  would  not  be  alert  to  the  sociological 
and  economic  aspects  of  this  problem  in  approving  plans  for  the  expenditure  of  this 
money? 

Miss  Lathrop.  I  do  not  want  to  admit  any  fears,  but  I  would  call  your  attention 
to  the  fact  that  the  plans  are  to  be  approved  by  a  board  on  which  a  representative  of 
the  Public  Health  Service  acts,  on  which  a  representative  of  the  Department  of  Agri- 
culture acts,  he  having  already  more  than  a  thousand  women  agents  doing  welfare 
work. 

Mr.  Hoch.  That  is,  assuming  that  we  amend  this  bill  and  make  it  directory  rather 
than — -I  mean,  make  it  mandatory  rather  than  directory.  This  bill  simply  gives  the 
authority  to  provide  a  board. 

Miss  Lathrop.  The  Senate  bill  has  changed  the  word  "authorized"  to  "directed." 
And  all  the  changes  in  the  way  of  restricting  the  bureau  and  restricting  the  adminis- 
tration which  are  in  that  Senate  bill  are  entirely  acceptable  to  the  bureau. 

Mr.  Lea.  Miss  Lathrop,  I  take  it  that  the  success  of  this  act  depends  on  cooperation 
both  from  the  administrative  side  and  from  the  standpoint  of  the  public,  does  it  not? 

Miss  Lathrop.  I  think  so,  sir. 

,Mr.  Lea.  Particularly  the  medical. profession,  whose  cooperation  you  deem  essen- 
tial here,  if  I  understand  you? 

Miss  Lathrop.  Y'es.  sir. 


246  PUBLIC  PPvOTECTIOlir   OF  MATERNITY  AND  INFANCY. 

Mr.  Lea.  And  you  expect,  if  you  administer  this  law,  to  fully  avail  yourself  of  the 
medical  facilities  that  are  necessary  to  perform  the  medical  part  of  it? 

Miss  Lathrop.  Yes,  sir. 

Mr.  Lea.  There  is  not  any  purpose  or  intention  on  your  part  to  eliminate  the 
physician  from  performing  the  physician's  part? 

Miss  Lathrop.  We  want  to  create  agencies  which  will  make  him  free  to  perform  it. 

Mr.  Lea.  Now,  the  physicians  represent  a  very  limited  and  specialized  portion  of 
the  public,  where  it  is  easy  to  get  cooperation  in  their  line  of  work.     Isn't  that  ao? 

Miss  Lathrop.  Yes,  sir. 

Mr.  Lea.  On  the  other  hand,  looking  at  it  from  the  standpoint  of  the  cooperation 
of  the  public,  which  is  absolutely  essential  to  the  success  of  this  measure,  what  would 
be  your  idea  of  the  value  of  your  organization  as  compared  with  the  health  depart- 
ment in  getting  mass  cooperation  of  the  public? 

Miss  Lathrop.  Well,  that  is  an  embarrassing  question.  Of  course,  I  can  not  but 
feel  that  our  organization  is  equipped  to  do  that,  and  that  we  can  do  it.  Perhaps  I  am 
mistaken  in  thinking  we  could  do  it  as  well  or  better  than  others,  but  I  confess  I  do 
think  that  we  are  equipped  to  do  it. 

Mr .  Le  A .  But  the  appeal  that  reaches  the  public  must  be  strictly  a  human  appeal. 

Miss  Lathrop.  Primarily  it  should  be. 

Mr.  Lea.  Now,  do  you  think  the  relations  of  your  bureau  to  the  public  are  such 
that  you  can  make  an  appeal  to  the  popular  sentiment  of  the  country  in  encoiu-aging 
support  as  strongly  as  any  organization  coiild? 

Miss  Lathrop.  I  do  not  know.  It  has  got  to  be  a  slow  thing,  whoever  does  it.  It 
is  a  matter  of  growth.  It  is  not  easy,  especially  with  the  present  financial  situation 
in  this  country,  to  prophesy  how  rapidly  we  can  make  a  bill  like  this  operate  to  create 
new  local  facilities. 

Mr.  Lea.  If  you  were  placed  in  charge  of  the  administration  of  this  law,  in  a  general 
way,  to  what  extent  do  you  think  it  would  be  necessary  to  dictate  the  policy  of  the 
State? 

Miss  Lathrop.  If  we  were  placed  in  charge  of  this  bill  to-morrow,  the  fibrst  thing 
we  should  do  would  be  to  correspond  with  all  the  States,  with  the  governors,  setting 
forth  exactly  the  limitations  of  the  bill  and  the  limitations  of  the  powers  of  the  bureau, 
and  with  the  State  boards  of  health,  asking  them  to  submit  what  they  thought  was 
the  wisest  way  in  which  they  should  use  the  money  in  that  State;  what  was  the 
most  necessary.  And  undoubtedly  there  would  be  the  greatest  divergence  in  the 
reports,  so  that  it  would  be  practically  impossible  to  make  any  one  uniform  plan, 
nor  would  it  be  in  the  least  desirable;  but  if  people  are  acting  in  good  faith  and  are 
competent  in  the  State,  their  plans  ought  to  be  supported  and  helped. 

Mr.  Lea.  But  the  proper  administration  of  this  law  from  the  Federal  standpoint 
would  require  in  some  instances  the  vetoing  of  State  plans,  would  it  not? 

Miss  Lathrop.  Well,  I  do  not  think  it  comes  to  a  veto.  That  is  a  pretty  formal 
thing.  I  think  if  things  did  not  go  well  we  would  send  somebody  out  there  to  see 
what  was  the  matter,  and  work  out  some  kind  of  a  sensible  compromise. 

Mr.  Lea.  But  that  is  the  purpose  of  giving  the  Federal  Government  this  power, 
to  prevent  the  expenditure  of  this  money  on  the  plans  that  the  Children's  Bureau 
would  not  deem  advisable. 

Miss  Lathrop.  And,  of  course,  this  advisory  overhead  committee,  and  undoubtedly 
other  advisory  committees  would  be' consulted.  Of  course,  Mr.  Lea,  I  think  any- 
body who  has  watched  those  places  in  the  various  governmental  units  of  this  country, 
where  subsidies  are  being  given  without  any  check  or  any  responsibility,  would  all 
feel  that  however  noble  and  generous  the  purpose  was,  there  had  been  great  waste 
and  great  disappointment  in  results.  I  do  not  think  the  Federal  Government  could 
well  offer  gifts  without  asking  to  be  assured  that  they  were  faithfully  spent. 

Mr.  Lea.  Now,  about  that  advisory  committee,  do  you  think  that  that  is  essential 
or  necessary  to  the  success  of  this  plan? 

Miss  Lathrop.  Well,  I  would  like  it,  anyhow. 

Mr.  Lea.  As  a  general  thing  my  experience  has  been  that  an  advisory  committee  is  a 
nuisance.  They  mess  up  policies  and  administrative  proceedings,  without  assuming 
responsibility,  and  they  form  a  method  of  evasion  of  responsibility  of  those  upon  whom 
the  burden  really  rests.  I  believe  the  people  who  have  the  active  responsibility 
should  assume  that  responsibility. 

Miss  Lathrop.  The  bureau  has  enjo^^ed  the  cooperation  of  very  helpful  ad\i8ory 
committees,  for  instance,  those  who  worked  on  this  book  called  "Standards  of  Child 
Welfare,"  to  which  critical  reference  has  been  made.  All  were  great  American 
authorities,  medical,  social,  and  economic,  without  money  and  without  price,  they 
have  aided  the  bxireau.  The  bureau  advisory  committee  of  pediatrists  is  another 
example,  and  others.  The  bureau  is  very  much  indebted  to  advisory  committees,  and 
I  believe  this  one  will  be  all  right. 


PUBLIC   PROTECTIOlSr   OF   MATERNITY   AND   INFANCY.  247 

Mr.  Lea.  Well,  of  courso,  it  was  not  with  any  idea  of  su^gestinp;  that  you  should 
refuse  to  avail  yourself  of  the  best  possible  advice,  but  I  think  it  would  be  pretty 
difficult  for  the  head  of  the  Children's  Bunsau  to  refuse  the  advice  of  the  advisory 
committee  that  is  ])ropo8ed  here,  and  if  the  ])lans  failed  to  work  out  successfully,  the 
Children's  Bureau  would  lay  it  to  poor  advace,  and  the  advisory  board  would  assume 
no  responsibility. 

Miss  LATjriioi'.  There  are  three  to  one.     They  oup;ht  to  be  right. 

Mr.  T.EA.   Hui  the  troubU;  is  we  have  no  one  reH])onHible. 

Mr.  Webstki!.  Miss  Tjathrop,  as  I  ,G;ather  the  line  of  Mr.  Hoch's  (|uestioning,  he  has 
been  endeavorins?  to  show  that  this  bill  involved  an  inconsistency  in  that  it  placed  the 
administration  of  the  act  o;enerallv  in  the  (!hildren's  Bureau;  yet  when  the  activities  of 
the  bureau  reached  the  States,  they  were  required  to  act  throui^h  State  agencies.  It 
occurs  to  me  that  the  law  is  not  capable  of  that  interpretation.  Section  4  of  the  act 
provides: 

"That  in  order  to  secure  the  benefits  of  the  appropriations  authorized  in  section  2  of 
this  act,  any  State  shall,  through  the  legislative  authorities  thereof,  accept  the  pro- 
visions of  this  act  and  designate  or  authorize  the  creation  of  a  State  agency  with  which 
the  ( 'hildren's  Bureau  shall  have  al I  necessary  powers  to  cooperate  as  herein  provided. ' ' 

Now,  the  only  limitation  upon  that  is  in  this  proviso: 

"Provided,  That  in  any  State  having  a  child  welfare  or  child  hygiene  division  in  its 
State  agency  of  health,  the  said  State  agency  of  health  shall  administer  the  provisions 
of  this  act  through  such  divisions." 

Is  it  not  correct  to  say  that  under  this  statute  it  leaves  to  the  State  the  definition  of  its 
own  agencies  through  which  this  cooperation  is  to  be  brought  about? 

Miss  LATHiior.  Yes,  it  is,  Judge  Webster;  but  as  a  matter  of  fact,  of  course  38  of  the 
States  now  ha\-e  child  hygiene  di^'isions.  We  want  to  have  the  State  boards  of  health 
get  these  child  hygiene  divisions  to  do  this  humanizing  work  toward  children  and  show 
that  they  have  a  social  trend  in  their  medical  work. 

Mr.  Webster.  Precisely  so,  and  that  is  the  reason  this  bill  provides  that  in  any 
State  whare  pro\'ision  has  been  made  for  such  a  child  welfare  and  child  hygiene 
di\'ision  in  the  State  agency  of  health,  this  bill  shall  be  administered  through  those 
divisions. 

Miss  Lathrop.  Yes. 
-    Mr.  HocH.  I  do  not  want  to  get  into  a  controversy  with  Judge  Webster;  but  simply 
that  we  may  straighten  this  out  as  I  see  it,  you  say  that  as  a  matter  of  fact  there  are 
38  States  which  now  have  these  child  welfare  or  child  hygiene  divisions.     They, 
however,  are  entirely  subordinate  to  the  State  health  department,  are  they  not? 

Miss  Lathrop.  Yes,  indeed. 

Mr.  Lea.  And  so  far  as  the  responsibility  and  the  direction  of  the  policy  is  con- 
cerned, not  the  subordinate  division  but  the  State  health  agency  is  the  responsible 
unit,  is  it  not? 

Miss  Lathrop.  That  is  just  the  point.  We  want  them  to  ba  responsible  for  direct- 
ing child-welfare  work,  recognizing  the  social  environment. 

Mr.  Lea.  As  a  matter  of  fact,  instead  of  denying  my  proposition,  the  principle  of 
it,  you  are  anxious  that  the  State  boards  of  health  shall  be  the  agencies  through  which 
this  work  shall  be  done? 

Miss  Lathrop.  Yes;  we  want  to  work  with  them. 

Mr.  Webster.  But  you  want  it  done  through  divisions  of  child  welfare  and  child 
hygiene. 

Miss  Lathrop.  Yes. 

Mr.  Webster.  Which  this  bill  providss  for. 

Miss  L.\.THROP.  It  does  not  force  thsm  in  any  way,  except  that  it  suggests  that  it 
would  like  to  cooperate  with  the  boards  that  have  them. 

Mr.  Hawes.  Miss  Lathrop,  this  law,  in  my  opinion,  is  a  departure  from  any  similar 
enactment  that  we  have  ever  made  in  the  United  States,  and  its  administration, 
therefore,  becomes  the  real  important  consideration,  so  far  as  I  am  con  earned.  But 
that  is  not  defined  in  the  law,  except  in  a  general  way — that  is,  you  will  administer 
the  law,  at  least  I  personaJly  hope  that  you  will — and  I  wanted  to  ask  you  soma  ques- 
tions about  how  this  administration  mil  be  brought  about. 

la  the  first  place,  the  National  Congress  will  be  called  upon  to  appropriate  $1,480,000 
for  the  national  end  of  this  work.  Then  the  States  -will  be  asked  for  a  similar  amount 
on  the  match  basis  of  Federal  aid.  Having  arrived  at  the  appropriation,  the  States 
ha\'ing  met  the  Federal  aid,  where  will  the  jurisdiction  lie  in  the  expenditui'e  of  this 
money?    If  I  do  not  make  myself  perfectly  clear,  I  hope  you  will  stop  me. 

Miss  Lathrop.  I  understand  that  upon  the  certification  that  the  money  has  been 
appropriated  properly  and  expended  properly  for  the  last  quai'ter,  that  the  quarter's 
appropriation  will  be  sent  through  the  Treasury  in  the  usual  way,  so  far  as  the  Govern- 
ment's side  goes.     That  is  the  usual  machinery.     After  the  plans  are  approved  and 


248  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

acted  upon,  I  understand  that  the  appropriation  goes  automatically  for  the  period 
for  which  th3  plans  last. 

Mr.  Hawes.  Let  us  take  an  exact  case.  Let  us  take  Missomi,  for  instance.  We 
will  say  that  Missouri  receives  $10,000,  and  in  addition,  $30,000;  that  she  creates  a 
depai'tment  of  health  with  a  branch  siroilar  to  yours,  a  children's  department  under 
that.  Now  we  have  reached  that  status.  Who  "will  direct  that  bureau  in  Missouri, 
your  department? 

Miss  Lathrop.  Oh,  not  at  all.  That  bureau  will  be  under  the  Department  of 
Health,  exactly  as  we  are  under  the  Department  of  Labor,  exactly  as  the  Public 
Health  Service  is  under  the  Treasury,  and  the  head  of  the  Health  Department  will  have 
the  general  direction,  of  course,  of  every  bureau  under  it,  and  I  suppose  the  appoint- 
ment of  all  the  officers,  unless  it  may  be  the  governor  will  appoint  them. 

Mr.  Hawes.  Suppose  that  the  head  of  the  State  agency  believes  that  the  proper 
way  to  treat  maternity  and  child  welfare  is  one  way.  and  you  directly  disagree  with 
with  the  head  of  that  State  agency;  who  is  to  control  in  a  case  of  that  kind?  Suppose 
they  put  out  a  prospectus  which,  in  your  opinion,  is  entirely  Avrong? 

Miss  Lathrop.  May  I  answer  by  a  question? 

Mr.  Hawes.  Yes. 

Miss  Lathrop.  Do  you  believe  that  there  is  any  question  that  could  arise  between 
the  bureau  and  the  State  of  Missouri  so  difficult  as  the  question  that  has  apparently 
been  settled  to-day  between  the  Children's  Bareau  and  the  Public  Health  Service 
by  an  honest  agreement  to  compromise? 

Mr.  Hawes.  I  don't  think  that  such  a  situation  will  arise,  frankly,  but  it  is  a  matter 
that  is  important  to  find  out,  as  to  will  be  supreme  in  the  last  analysis. 

Miss  Lathrop.  May  I  just  refer  to  one  thing  before  I  answer?  As  I  understand, 
as  the  bill  passed  the  Senate,  it  includes  the  appeal  to  the  President  if  the  agree- 
ment— ^it  includes  a  provision  which  is  not  in  the  Towner  bill  as  it  stands  here,  that 
lies  to  the  President  of  the  United  States — ^if  there  is  a  disagreement  or  a  refusal  by 
the  biireau  to  furnish  funds  to  which  the  States  claim  they  are  entitled. 

Mr.  Hawes.  In  that  case,  when  there  is  a  dispute  the  President  of  the  United  States 
will  settle  it. 

Miss  Lathrop.  If  it  came  to  the  refusal  of  funds.  If  we  could  not  get  to  an  agree- 
ment. 

Mr.  Hawes.  Well,  now,  we  have  agreed  on  the  funds. 

Miss  Lathrop.  Yes. 

Mr  Hawes.  The  statement  that  I  am  giving  to  you  is  that  there  is  an  exact  agree- 
ment on  the  fund  and  an  agreement  upon  the  agency  that  is  satisfactory  to  you,  but 
the  State  agency  decides  that  it  wants  to  proceed  one  way,  and  you  think  it  is  wrong; 
what  would  happen?  -, 

Miss  Lathrop.  I  think  that  is  exactly  where,  if  we  could  not  compromise,  if  we 
could  not  as  sensible  people  on  both  sides  compromise  with  the  people  who  would  be 
the  authorities  back  of  the  State  board  and  back  of  the  national  board;  if  we  could  not 
reach  a  compromise,  unquestionably  the  Federal  bureau,  if  it  felt  it  important  enough, 
would  decline  to  pay  the  money  and  an  appeal  on  the  part  of  the  State  would  then 
lie  to  the  President  of  the  United  States. 

Mr.  Hawes.  Suppose  the  head  of  the  State  agency  was,  in  your  opinion,  incom- 
petent or  an  improper  person  to  handle  maternity  and  child  hygiene  in  my  State, 
or  suppose  this  person  appointed  by  the  health  department  and  confirmed  by  the 
State  Senate  was  personally  objectionable  to  your  department,  would  you  have  any 
authority  for  removal  of  that  person? 

Miss  Lathrop.  No,  sir. 

Mr.  Hawes.  We  are  clearing  up  things.  These  are  not  questions  that  I  am  asking 
you,  Miss  Lathrop,  in  an  antagonistic  way  at  aU. 

Miss  Lathrop.  I  did  not  mean  to  answer  in  that  way,  Mr.  Hawes. 

Mr.  Hawes.  I  want  to  go  a  little  bit  further.  Would  you  recommend  to  a  State 
department  the  employment  of  its  agents? 

Miss  Lathrop.  Do  you  mean  have  we  any  legal  right  or  warrant  to  do  it?  I  see 
none;  absohitely  none.  Of  course,  we  constantly  get  inquiries  now  from  all  sorts 
of  people — ^often  officials— asking  for  suitable  candidates  or  the  bureau's  opinion  of 
candidates.     We  furnish  information  if  we  have  it. 

Mr.  Hawes.  Well,  would  your  control,  then,  be  limited  approximately,  to  the 
same  control  that  the  national  Board  of  Health  would  have  over  a  State  board  of 
health? 

Miss  Lathrop.  I  do  not  know  the  terms  of  that  control,  but  I  see  no  control  that  we 
exercise  except  this  control  with  reference  to  plans. 

Mr.  Hawes.  The  question  is  important  for  this  reason:  In  one  State  we  are  informed 
that  the  State  has  spent  $5,000,000  or  $6,000,000  in  its  health  work,  another  State 


PUBLIC   PROTECTION"   OF   MATERNITY  AND   INFANCY.  249 

$2,500,000  ill  its  luialth  work,  which  i.s  all  .siiijplonuMited  hy  the  larger  sums,  vastly 
in  excess  of  this  State  ariioiint,  hv  the  local  centers;  against  that  the  United  States 
will  spend  in  a  State  $  10,000, 000  as  against  So.OOO.OOO  or  $0,000,000. 

Miss  L.vTiiiioi'.  May  I  make;  an  e.\))laiiation  there?  As  to  Pennsv hania,  that 
amount  of  over  $5,000,000  was  an  ai)i)ropriation  for  a  two->ear  ])eriod.  Nearly  half 
of  it,  I  think,  goes  into  the  maintenance  of  three  tuherculo.sis  ho.sjjitals.  Most  of  it 
is  taken  up  in  other  large  activities  of  the  State  as  a  whole.  I  do  not  know  whether 
any  other  institutions  are  invoh'ed  or  not,  and  we  are  authoritati^■ely  told,  in  a  com- 
munication which  Dr.  Rude  can  lay  before  you,  that  the  child-welfare  ap])ropriation 
for  the  State  from  the  State  fund  for  the  last  year  was  lees  than  $40,000 — I  think, 
$36,000. 

Mr.  Hawks.  So  that  it  was  approximately  about  as  much  as  the  Nation  would 
expend? 

Miss  L.VTHKOP.  Yes. 

Mr.  Hawks.  But  >'ou  know  that  that  would  not  take  care  of  ]5  jirospc^rous  counties 
in  a  proper  way,  with  nurses,  etc.  I  mean  to  say,  $80,000  would  not  do  the  work  as 
it  ought  to  be  done.  In  other  words,  this  whole  i)roblem  is  a  matter  not  of  millions, 
but  it  would  run  up  into  a  billion  if  it  was  properly  done. 

Miss  Latiirop.  I  do  not  believe  I  agree  to  that.  I  think  it  is  quite  true,  as  we 
said  here  this  morning,  that  the  whole  social  surroundings  of  a  community  come 
together  either  to  pull  up  or  to  let  down;  that  the  people  who  work  for  better  milk 
and  the  people  who  work  for  better  transportation,  who  work  for  better  sewage  disposal, 
they  all  are  serving  the  cause  of  public  health  and  they  therefore  are  serving  the 
cause  of  better  surroundings  for  mothers  and  babies.  There  is  a  natural  tendency, 
but  far  too  slow,  especially  in  our  backward  communities,  for  health  to  improve  in 
this  country.  I  do  not  believe  that  such  sums  as  that  will  ever  be  necessary,  espe- 
cially with  the  improvement  in  public  understanding  and  education  which  we  hope 
is  progressing. 

Mr.  Hawes.  Those  figures,  of  course,  are  based  on  the  doctors'  theory  of  the  medic- 
inal side  of  the  questions,  and  that  is  dependent  on  light,  heat,  food,  clothing,  and 
medical  care.  Is  it  your  idea,  Miss  Lathrop,  after  having  established  in  a  community 
in  a  State  a  satisfactory  State  agency  and  it  was  functioning  properly,  would  you 
pass  by  that  agency  and  establish  one  elsewhere? 

Miss  Lathrop.  Well,  I  do  not  understand  under  this  act  that  we  would  have  any 
power  to  establish  a  State  agency.  I  think  if  we  had  agents  enough  available  we 
could  undoubtedly  advise  and  give  information  as  to  the  way  in  which,  with  the  con- 
ditions of  that  particular  State,  whether  rural,  industrial,  or  big  city  populations 
are  most  involved,  money  could  best  be  spent. 

Through  the  bureau  information  could  be  constantly  gathered  and  disseminated 
as  to  successful  or  unsuccessful  work  and  as  to  cooperation  of  social  and  scientific 
agencies,  public  and  volunteer.  But  I  do  not  understand  that  we  have  any  further 
right. 

Mr.  Hawes.  Well,  we  will  confine  the  question  then  to  purely  educational  work. 
If  you  have  educated  a  center  of  population,  would  you  consider  your  work  nearly 
completed  in  that  section? 

Miss  Lathrop.  If  nobody  else  would  grow  up  there,  I  would.  But  I  think  life  is 
a  going  concern,  with  people  coming  along,  with  young  children  all  the  time. 

Mr.  Hawes.  Of  course,  I  would  not  tliink  that  you  would  consider  your  work  com- 
plete unless  you  had  established  State  agencies  that  would  take  care  of  the  growing 
population. 

Miss  Lathrop.  Of  com'se,  so  long  as  the  Government  puts  out  a  large  number  of 
publications,  then  I  suppose  that  there  will  always  be  a  demand  for  them;  but  other 
kinds  of  work,  of  course,  can  be  done,  perhaps  once  for  all. 

Mr.  Hawes.  The  object  of  my  inquiry,  the  second  inquiry,  is  this:  Congress  puts  a 
limitation  on  the  amount  of  money  it  can  spend  in  this  consolidation  called  the  Sweet 
bill  for  the  benefit  of  our  soldiers.  The  payments  are  to  discontinue  in  five  years.  I 
have  wondered,  and  I  would  like  to  know,  if  you  have  a  five-year  limit  to  create 
a  strong  central  organization  wliich  could  issue  educational  tracts  and  scientific  infor- 
mation of  various  kinds,  and  as  the  States  were  urged  in  the  meantime  to  establish 
local  agencies  with  the  benefit  of  this  Federal  aid  wliich  your  bill  provides  for — 
and  really  that  is  the  attractive  thing  in  it,  stimulating  the  local  State  pride  to  follow 
the  lead  of  the  Nation — could  we  not  well  say,  and  settle  forever,  any  question  of 
interference  with  States  rights,  that  this  law.  so  far  as  the  States  are  concerned,  should 
only  run  for  a  period  of  five  years? 

Miss  Lathrop.  I  think  five  years  for  improving  the  health  of  well  people  is  different 
from  five  years  for  dealing  with  health  questions  of  soldiers  which  may  arise  out  of 
accidents  and  exposure  due  to  the  war.  I  can  believe  that  questions  of  this  kind, 
that  all  questions  of  granting  aid  such  as  the  Government  already  has  made  in  several 


250  PUBLIC  PROTECTION   OF  MATERNITY  AND  INFANCY. 

laws,  might  well  be  reviewed  by_  Congress  at  some  stated  period  without  any  charge 
of  its  being  a  withdrawal  of  a  privilege  allowed.  _  I  believe  that  five  years  would  be 
very  short  for  the  first  period  in  a  measure  like  this,  but  I  tlunk  that  is  an  admirable 
suggestion,  this  power  of  Congress  to  review,  as  a  matter  of  routine,  and  determine  what 
the  continuing  appropriation  should  be,  if  any,  and  to  take  evidence  as  to  results 
so  that  if  the  facts  justified  the  Federal  appropriations  should  cease. 

Mr.  Hawes.  The  only  question  I  have  is  this:  There  is  a  movement  to  establish 
what  is  called  a  "national  welfare  bureau,"  which  will  take  under  its  head  the 
d  epartment  of  health,  also  all  soldier  agencies,  all  health  agencies  and  matters  that 
appertain  to  the  general  welfare  of  the  people.  I  am  afraid  this  commission  is  a  little 
far  in  the  future,  but  wouldn't  your  department  find  a  proper  place  in  such  a  com- 
mission in  case  it  was  established? 

Miss  Lathrop.  The  plans  that  have  been  shown  me  by  the  responsible  authorities 
have  indicated  that  they  thought  so.  Of  course  all  bureau  chiefs  obey  orders.  We 
should  go  wherever  we  were  put. 

Mr.  Hawes.  You  would  not  have  any  objection  to  your  bureau  coming  under  the 
general  welfare  commission  when  it  was  created? 

Miss  Lathrop.  Even  if  I  felt  an  objection,  I  should  not  allow  myself  officially  to 
feel  it. 

Mr.  Hawes.  I  will  state  it  another  way.     Would  there  be  any  objection? 

Miss  Lathrop  No;  I  think  not.  This  seems  to  be  rather  outside  of  the  record,  but 
I  have  heard  here  the  attack  that  was  made  upon  the  bureau  and  its  fitness  to  do  this 
work,  because  it  is  under  the  Department  of  Labor.  Personally,  I  feel  that  it  is 
rightly  placed  under  this  department  which  has  for  its  duty  to  improve  the  conditions 
of  the  great  masses  of  our  people,  and  I  have  seen  how  much  economic  and  social 
conditions  affect  the  welfare  of  people,  and  I  have  thought  it  was  a  good  thing  to  have 
a  bureau  like  ours  in  the  Department  of  Labor.  I  feel  the  difficulty  in  cooperation, 
although  I  believe  it  is  solely  a  question  of  how  the  Secretaries  determine  to 
control  bureaus,  as  to  secm-ing  cooperation.  But  if  it  were  in  the  economy  of  the 
future  thought  best,  I  can  see  sound  reasons  for  putting  it  in  the  department  of 
welfare. 

Mr.  Hawes.  Miss  Lathrop,  you  have  heard  the  discussions  in  the  hearings,  and 
there  seems  to  be  a  imanimity  of  opinion  amongst  the  opponents  of  this  bill  that  95 
per  cent  of  the  Government  insurance,  as  we  may  call  it,  against  the  loss  of  the  mother 
and  the  child,  is  controlled  by  the  medical  profession;  that  it  is  the  result  of  disease, 
of  heredity,  or  of  causes  that  only  medical  men  can  remedy.  Now  that  being  the 
case,  where  the  medical  profession  is  called  in,  how  could  your  department  do  that 
work  if  it  remains  as  it  is  at  present  constituted? 

Miss  Lathrop.  If  it  will  be  not  disrespectful,  I  should  not  accept  that  hypothesis, 
I  do  not  know  who  invented  that  95  per  cent  nor  what  statistical  basis  it  has,  but  so 
long  as  the  family  exists  and  children  stay  at  home  with  their  parents  the  greater  part 
of  the  24  hours  under  their  control,  I  can  not  see  how  life  can  be  95  per  cent  medical. 
Even  if  people  are  sick,  you  want  a  doctor  to  come  in  and  take  care  of  your  child  in 
your  household.     I  do  not  think  it  is  95  per  cent  of  the  situation. 

Mr.  Hawes.  We  have  the  average  case  of  the  woman  and  the  child  needing  atten- 
tion at  the  period  of  cMldbirth. 

Miss  Lathrop.  For  a  few  hours  or  a  few  days,  or  perhaps  months.  Scientific  medical 
and  nursing  care  is  one  absolute  and  indispensable  essential,  and  there  is  nothing  to 
take  its  place.  What  we  want  to  do  is  to  make  it  possible  for  that  woman  and  child 
to  have  that  very  best  of  attention.  It  means  a  great  many  other  elements  in  order 
to  make  sure  of  that.     We  make  sure  of  it  now  for  a  very  small  part  of  our  population. 

Mr.  Hawes.  I  think  one  of  these  doctors  puts  in  the  record  the  various  causes  of 
death  dtuing  maternity,  numbered  1,  2,  3,  4,  5,  6,  7,  and  so  forth,  claiming  that  they 
were  nearly  all  medicinal,  requiring  the  services  of  a  doctor.  I  hope  I  am  not  con- 
fusing you.  I  mean  where  is  your  doctor  going  to  come  in  in  yoiu  scheme  of  organiza- 
tion if  that  is  even  approximately  true?  If  it  is  only  50  per  cent  true,  where  are  you 
going  to  put  in  the  doctor? 

Miss  Lathrop.  Why,  I  suppose  he  will  come  in  just  where  he  comes  in  now,  except 
that  we  hope  that  there  will  be  more  qualified  physicians.  The  country  must  depend 
upon  the  local  communities  for  practicing  physicians,  and  of  coiuse  upon  local  hos- 
pitals in  the  main.  I  agree  that  there  is  always  medical  cause.  But  I  think  also  of 
what  a  father  whom  a  friend  of  mine  saw  on  the  railroad  train  said  about  his  child. 
He  had  come  in,  giving  up  a  day's  work  to  bring  this  child  to  a  clinic,  and  he  was  so 
ignorant  and  untaught  that  he  could  ha.rdly  express  himself  properly,  but  he  was 
concerned  beyond  all  measure  about  this  little  child  who  lay  in  his  arms,  and  he  turned 
to  my  friend  and  said ,  ' '  The  doctor  says  it  is  neglect.  Do  you  know  what  that  means? ' 
Back  of  the  medical  cause  is  the  neglect  of  ignorance  in  so  many  instances  that  ii 


PUBLIC  PROTECTION'   OF   MATERNITY  AND  INFANCY.  251 

eeeniH  to  me  the  Commonwealth  ouglit  to  make  gieat  efforts  to  make  that  sort  of  un- 
<;onscioiis  and  unwilling,'  net,'lect  impossible.  I  do  not  know  that  I  have  answered 
your  question. 

Mr.  HXWES.  I  think  you  liave  very  well. 

Mr.  Rayhurn.  MivMs  Lathrop,  as  the  head  of  tlie  Children's  Bureau,  under  tliis  bill 
your  organization  is  practically  absolute,  so  far  as  being  the  executive  is  concerned? 

Miss  Lathrop.   1  did  not  quite  understand  you. 

Mr.  Rayhurn.  As  the  head  of  the  Children's  iJuroau,  the  position  that  you  hold 
now  under  the  authority  granted  in  this  l)ill  is  practically  absolute,  so  far  as  the  ad- 
ministration of  this  law  is  concerned,  is  it  not? 

Miss  IjAthrop.  I  suppose  so,  in  a  narrow  sense.     It  seems  to  me  carefully  defined. 

Mr.  Rayhurn.  This  ad\isory  committee  that  is  authorzed  here — you  say  that  was 
■ilirectcd  yesterday  in  the  Senate? 

Miss  Lathrop.   I  saw  an  amendment  of  that  kind. 

Mr.  Rayhurn.  But  that,  of  course,  would  not  have  any  effect  upon  the  ultimate 
■outcome  of  the  ad\'ice  of  that  committee? 

Miss  Lathrop.  Of  course  it  just  depends — some  people  don't  know  enough  to  take 
good  advice,  but  if  we  do,  then  it  would  be  taken. 

Mr.  Rayhurn.  1  understand  that,  Ijut  the  point  I  was  making  was  simply  this,  that 
even  though  the  head  of  the  Children's  Bureau  is  directed  to  appoint  this  advisory 
committee,  there  is  nothing  that  makes  what  they  say  final,  or  in  conference  with  the 
head  of  the  Children's  Bureau  final,  but  after  they  have  given  their  advice,  then  the 
head  of  the  Children's  Bureau  makes  up  the  policy  independently  and  entirely.  I 
mean  they  can  do  that.  Of  course  any  sensible  person,  as  you  say,  ought  to  take 
ad\'ice,  but  there  is  nothing  in  this  language  here  that  will  cause  them  to  feel  bound 
to  take  that  advice. 

Miss  Lathrop.  The  bill  originally  provided  a  controling  board,  and  it  was  stricken 
out' because  it  was  said  that  the  responsibility  must  be  centered  somewhere;  that 
you  could  have  advice  but  you  could  not  dodge  responsibility. 

Mr.  Rayburn.  You  think  that  is  wiser  than  to  constitute  the  head  of  the  Children's 

Bureau,  the  Secretary  of  Agriculture,  the  Surgeon  General  of  the  United  States  Public 

*  Health  Ser\ice,  and  United  States  Commissioner  of  Education  an  executive  board? 

Miss  Lathrop.  I  do  not  want  to  say,  because  I  did  suggest  that  and  the  Senate 
voted  it  down. 

Mr.  Rayburn.  And  you  thought  that  that  would  probably  be  wise,  did  you? 

Miss  Lathrop.  I  did.  I  wanted  to  dodge  the  direct  responsibility  and  to  have  the 
country  see  at  once  that  all  these  elements  were  interested  in  making  this  effective . 

Mr.  Barkley  (in  the  chair).  Pardon  me,  Mr.  Rayburn,  I  understood  your  question 
to  be  referring  to  an  executive  board? 

Mr.  Rayburn.  Yes. 

Mr.  Barkley.  And  am  I  right  in  thinking  you  so  understood  it,  executive  or 
advisory? 

Miss  Lathrop.  I  understood  that  he  wished  to  know  if  those  agencies  were  originally 
an  executive  board? 

Mr.  Rayburn.  No. 

Miss  Lathrop.  Or  if  I  thought  they  should  be? 

Mr.  Rayburn.  Yes;  that  is  what  I  asked. 

Miss  Lathrop.  And  I  replied  that  in  the  original  draft  all  those  agencies  save  the 
Department  of  Agriculture,  which  we  did  not  dare  put  in  because  it  made  the  board 
too  big,  were  an  executive  board,  and  that  the  Children's  Bureau  chief  was  the  ex- 
ecutive of  that  board,  and  that  was  changed  in  the  Senate. 

Mr.  Ray'burn.  That  the  head  of  the  Childi-en's  Bureau  was  to  carry  out  the  de- 
cisions of  this  board? 
-     Miss  Lathrop.  Yes.     That  was  changed,  not  on  my  request  or  desire. 

Mr.  Rayburn.  I  did  not  know  anything  about  that.  My  question  was  entirely 
impersonal,  because  we  do  not  know  who  is  going  to  be  in  our  place  to-morrow  or  who 
is  going  to  be  in  yours,  or  who  is  going  to  be  Secretary  of  Agriculture;  we  have  to 
legislate,  you  know,  not  with  regard  to  the  indi\'idual  holder  of  office  now  but  for 
next  year  or  five  years  from  now.     That  was  what  my  question  was  directed  to. 

Mr.  Mapes.  I  would  like  to  ask  Miss  Lathrop  one  question.  There  has  been  some 
criticism  here  on  account  of  the  latitude  given  in  section  9  of  the  bill  to  make  arrrange- 
ments  with  any  educational  institutions  for  the  provision  of  extension  courses  by 
qualified  lecturers.  I  understand  that  the  Senate  yesterday  qualified  that  by  putting 
an  amendment  after  the  words  "any  educational  institution"  like  this:  "Approved 
for  this  purpose  by  the  L^nited  States  Commissioner  of  Education.  "  Does  that  amend- 
ment meet  with  your  approval? 

Miss  Lathrop.  Heartily. 


252  PUBLIC  PROTECTION   OP   MATERNITY  AND  INFANCY. 

Mr.  Hawes.  Just  on  that  point,  I  understand  that  the  State  agency  is  to  be  desig- 
nated by  the  legislature  to  cooperate  with  your  department.  Why  should  not  the 
designation  of  the  educational  institution  be  left  to  the  State  agency? 

Miss  Lathorp.  I  think  that  the  bill  reads  that  in  any  State  having  a  child  welfare 
or  a  child  hygiene  division  in  the  State  agency  of  health,  the  State  agency  of  health 
shall  administer  the  provisions  of  the  act  through  such  division. 

Mr.  Hawes.  That  is  right.  Now  section  9  is  the  one  that  you  state  was  amended 
in  the  Senate,  permitting  the  National  Department  of  Education  to  designate  the 
educational  institutions? 

Miss  Lathrop.  As  I  understand  it,  the  United  States  Commissioner  of  Education 
is  engaged  in  examining  and  standardizing  the  higher  educational  institutions.  He 
issues  reports  constantly,  explaining  exactly  what  their  courses  and  qiialifications 
are.  At  first  this  bill,  as  I  recall,  provided  any  public  educational  institutions  might 
be  used,  really  having  in  view  the  land-grant  colleges,  the  public  universities,  some 
of  which  have  medical  schools,  hospitals,  nursing  schools,  and  extension  services. 

Mr.  Hawes.  That  brings  me  back.  Miss  Lathrop,  to  my  original  question,  and  it  is 
a  case  in  point.  Suppose  we  have  a  State  agency  that  designates  the  State  university 
as  the  proper  place  to  carry  on  this  educational  work;  now  the  national  Commissioner 
of  Education  would  designate  a  school  of  mines  or  a  hospital  university. 

Miss  Lathrop.  Oh,  not  so  bad  as  that. 

Mr.  Hawes.  It  might  happen.  There  is  quite  a  fight  on  in  the  various  States 
sometimes,  you  know,  over  those  things.  ISfow  where  there  is  a  conflict  of  that  kind, 
should  it  not  be  cleared  up  in  this  bill  so  there  would  not  be  any  question  about  where 
the  power  lay?  There  would  be  no  objection  to  an  amendment  of  that  kind,  would 
there? 

Miss  Lathrop.  I  think  there  is  no  objection  to  any  amendment  that  protects  the 
public  from  having  half-baked  or  ignorant  lecturers,  and  that  would  provide  that 
such  lecturers  shall  come  from  the  very  highest  educational  soiuces. 

Mr.  Hawes.  We  will  agree  upon  that;  but  who  is  to  decide  the  standard,  the  Child- 
ren's Bureau  in  Washington  or  the  children's  bureau,  say,  in  Missouri? 

Miss  Lathrop.  Of  course  it  was  thought  when  this  bill  was  first  drafted  that  these 
State  institutions  with  their  very  great  extension  services,  such,  for  instance,  as  the 
State  of  Wisconsin  has,  might  enormously  help  the  efficiency  of  this  measure,  not  only 
by  direct  lectures  on  hygiene  and  maternity  and  infancy,  but  by  those  subsidiary 
courses  on  matters  affecting  family  health,  like  the  conduct  of  the  household  in  regard 
to  food,  etc. ,  perhaps  not  included  in  a  precise  definition  of  hygiene.  My  judgment  is 
that  what  we  should  have  is  something  which  is  a  respected  authority  so  that  there 
shall  not  be  some  poor  and  ill-advised  selections.     That  is  all. 

Mr.  WiNSLOw.  Mr.  Chairman,  I  would  like  to  ask  a  question  or  two.  Miss  Lathrop, 
I  would  like  to  ask  you  if  you  have  knowledge  of  the  fact  that  some  time  during  these 
hearings  some  person  asked  the  Assistant  Secretary  of  the  Treasury,  who  is  at  the 
head  oi  the  Public  Health  Ser-vice,  to  issue  an  order  to  the  effect  that  no  representa- 
tive of  that  department  should  attend  these  hearings? 

Miss  Lathrop.  I  have  no  personal  knowledge  of  any  relations — of  any  connection 
between  any  of  the  Assistant  Secretaries  or  anybody  else  with  anything  of  that  kind. 

Mr.  WiNSLOw.  You  have  never  heard  that  that  has  been  done? 

Miss  Lathrop.  I  do  not  know  whether  I  have  heard  that  that  had  been  done  or 
not. 

Mr.  WiNSLOw.  Y'ou  mean  your  memory  is  faulty  in  respect  to  that? 

Miss  Lathrop.  I  mean  I  "do  not  know  just  exactly  what  I  have  heard  as  to  the 
possible  appearances  here.  I  want  to  say  this:  If  anybody  has  ever  done  that,  it  has 
been  without  my  knowledge  or  consent  or  approval,  or  that  of  anybody  connected 
with  the  Children's  Bureau. 

Mr.  WiNSLOw.  Does  the  question  suggest  a  familiar  sound  to  your  ear? 

Miss  Lathrop.  Sir? 

Mr.  WiNSLOw.  Does  the  question  suggest  something  that  is  more  or  less  familiar 
to  vour  ear? 

Miss  Lathrop.  What  I  want  to  say  is  this:  I  would  only  be  -willing  to  speak  for 
myself  and  for  my  own  knowledge  of  these  things.  In  no  manner  have  I  suggested  or 
desired  to  suggest  or  had  any  knowledge  of  anybody  connected  with  the  bureau 
making  any  suggestion,  either  to  the  Public  Health  Service  indirectly  or  directly,  or 
to  anybody  else  that  the  Public  Health  Service  should  not  attend  these  hearings. 

Mr.  WiNSLOW.  But  you  are  not  sure  whether  you  ever  heard  about  it  or  not? 

Miss  Lathrop.  Well,  I  may  have  heard  more  or  less  gossip,  which  I  do  not  care  to 
discuss,  but  those  are  the  facts  so  far  as  I  am  concerned,  and  so  far  as  the  bureau  which 
I  represent  is  concerned. 

Mr.  WiNSLOW.  Then  you  know  nothing  about  it  as  a  matter  of  report? 

Miss  Lathrop.  I  have  not  said  that  I  knew  nothing  about  it  as  a  matter  of  report. 
I  said  I  did  not  care  to  go  farther  in  stating  what  gossip  I  may  have  heard.     I  do  not 


PXJBLIC  PEOTECTIOIir   OF   MATEENITY  AND  INFANCY.  253 

feel  that  that  is  exactly  my  i)ioviii(('.  I  <lo  know,  Afr.  Chairman,  since  I  see,  I  think, 
the  trend  of  your  (nie/ttions  that  the  conference  this  morniriij;  was  one  in  good  faitli 
■on  l)oth  sides,  and  one  whicli,  had  you  heen  present  you  wouhl  have  heen  entirely 
-satisfied  was  in  candor  and  t^ood  failh. 

Mr.  WiNsi.ow.  Well.  1  daresay.     I  do  not  know  anythinpf  ahout  thai. 

Mr.  15.\RKLKY  (presiding).  Are  there  any  further  questions? 

Mr.  Denison.   I  want  to  ask  a  (pie-ttion. 

Mr.  HuDULKsToN.  Mr.  Cliairnian,  may  I  sugi':est  that  Ju<l,L»f'  Towner  has  only  an 
hour  left. 

Mr.  TowNKii.   1  have  three  other  witnesses. 

Mr.  lIuDDr.KSTON.  And  it  strikes  me  that  to  keep  the  witness  before  the  comnriittee 
any  lont;:er  is  hardly  fair  to  Judue  Towner.  I  submit  that  for  Mr.  Denison's  considera- 
tion. 1  do  no)  want  to  shut  y\f.  Denison  off  or  any])ody  else,  but  1  rather  deplore 
that  we  are  cuttinji'  Judge  Towner  so  short. 

Mr.  Denison.  Well,  if  that  is  the  way  Judge  Towner  feels  about  it  I  will  not  ask 
any  questions  at  all. 

Mr.  Tow'NER.  If  you  only  want  to  ask  one  question  go  ahead,  Mr.  Dension. 

Mr.  IIawes.  I  suggest  we  extend  the  hearing  a  little  bit  further. 

Mr.  lIuDDLE.sTON.  We  made  a  decision  about  that  and  we  must  close  at  5  o'clock, 
according  to  the  decision  which  the  committee  made,  and  I  am  going  to  insist  on 
closing  at  that  time  myself. 

Mr.  T(jwNEi{.  Ask  your  question,  Mr.  Denison. 

Mr.  Denison.  I  wanted  to  ask  one  more  question,  and  if  you  have  covered  it, 
why  just  indicate  and  I  will  withdraw  the  question.  In  the  publication  to  which 
you  referred,  I  believe,  which  has  been  mentioned  here,  gotten  out  by  the  bureau, 
Miss  Lathrop,  entitled  "Maternity  Benefit  Systems  in  Foreign  Countries,"  there 
was  expressed  this  conclusion,  which  I  quote: 

■'Maternity  benefit  systems  are  not  an  experiment.  Germany,  Austria,  and  Hun- 
gary early  established  such  systems.  In  some  systems  the  benefits  consist  primarily 
in  a  money  payment.  In  others  it  consists  primarily  in  medical  and  nursing  serv- 
ices. No  such  system,  once  undertaken,  has  ever  been  abandoned.  Instead,  the 
tendency  of  changes  in  existing  legislation  has  always  been  toward  including  larger 
and  larger  groups  of  population,  toward  increased  benefits,  and  toward  the  compul- 
sory, as  contrasted  with  the  voluntary,  principle  of  insurance.  " 

Miss  Lathrop.  I  think  that  is  an  entirely  scientific  statement  of  the  facts  as  they 
exist  in  the  European  countries.  Of  course  the  war  made  a  great  enlargement  of 
facilities  all  over  the  continent,  as  well  as  in  England. 

Mr.  Denison.  And  is  that  your  judgment  of  the  tendency  of  this  legislation? 

Miss  Lathrop.  It  it  a  tendency  that  I  can  not  but  hope  we  shall  in  some  degree 
begin  to  stem  by  this  voluntary"  provision.  In  the  proceedings  you  will  see  that 
I  tried  to  express  my  own  feeling  of  what  the  American  spirit  really  wanted  and 
would  tolerate. 

Mr.  Denison.  Well,  I  still  do  not  get  it.  Is  it  your  judgment.  Miss  Lathrop, 
that  when  we  once  begin  on  this  benefit  legislation,  that  the  tendency  is  invariably 
to  go  further  and  further  and  tend  more  and  more  toward  compulsory  as  compared 
with  voluntary  benefits? 

Miss  Lathrop.  No;  I  think  that  is  exactly  what  has  happened  with  the  labor 
insurance,  the  health  insurance  in  England.  I  hope  not  to  see  a  compulsory  method 
here.  I  suppose  we  have  got  comi)ulsion  in  the  retirement  provisions  and  contri- 
butions in  the  Government  service,  but  that  is  a  very  different  thing  from  getting 
compulsion  by  which  every  working  woman  must  carry  a  card  and  have  stamps 
put  on  it  every  week.  To  me  it  is  a  very  inadequate  and  un-American  system.  I 
don't  know  how  more  clearly  to  say  that  it  is  not  a  question  of  my  opinion  or  desire 
either,  but  solely  of  what  has  been  the  result  on  the  (continent. 

Mr.  Barkley  (presiding).  May  I  ask  one  question  there  in  further  explanation 
of  this  excerpt  which  seems  to  have  been  taken  from  a  voluminous  docurnent  of 
yours.  What  you  mean  by  saying  that  it  was  not  an  experiment  is  this,  that  in  Eur- 
ope it  has  been  adopted  as  a  permanent  system,  and  therefore  it  is  not  experimental, 
and  the  tendency  has  been  to  increase  the  facilities  rather  than  to  decrease  them  in 
Euro])e,  but  vou  do  not  mean  by  that  in  any  way  to  recommend  them  for  the  United 
States? 

Miss  Lathrop.  No,  I  do  not,  and  I  dislike  it  so  much  that  I  was  very  careful— 
perhaps  I  learned  the  other  way — in  the  letter  of  transmittal,  or  elsewhere,  to  put  no 
color  of  my  own  judgment  into  it.     IMy  opinion  is  not  very  important. 

Mr.  Barkley.  That  is  a  historical  document,  to  be  taken  for  whatever  it  may  be 
worth,  in  connection  with  our  own  progress? 

Miss  Lathrop.  That  is  what  was  intended.     I  thank  you. 

Mr.  Towner.  Mr.  Chairman,-  I  call  Dr.  Rude,  of  the  Children's  Bureau,  who  will 
speak  very  briefly. 


254  PUBLIC  PKOTEOTION  OF  MATERIsriTY  AND  INFANCY. 

STATEMENT  OF  DR.  ANNA  E.  RUDE,  DIRECTOR  OF  THE  HYGIENE 
DIVISION  OF  THE   CHILDREN'S  BUREAU,  WASHINGTON,  D.   C. 

Dr.  Rude.  In  ^dew  of  tlie  fact  that  we  are  infringing  upon  Judge  Towner's  time,  I 
shall  refrain  from  answering  the  many  questions  that  I  should  like  to  answer.  How- 
ever, if  I  maybe  allowed  to,  I  will  answer  the  last  question wliich  Mr.  Rayburn  askedl 
relative  to  a  Federal  board.  The  bill  which  this  committee  considered  last  year  did 
provide  for  such  a  board,  and  it  was  after  conference  with  the  State  health  officers, 
who  met  here  in  December  of  last  year  and  appointed  a  committee  to  come  over  and 
adsuse  with  the  bureau,  that  the  organization  of  the  board  was  changed  to  its  present^ 
form,  simply  because  from  previojs  experience  with  interdepartmental  boards  the 
State  health  office  felt  that  these  cooperative  plans  in  Government  bureaus  did  not 
function  as  ef'fectively  as  where  one  person  was  responsible  for  the  administration. 
I  will  not  take  any  more  of  your  time. 

ilr.  Towner.  I  call  Mrs.  Upton  to  the  stand. 

STATEMENT  OF  MRS.  HARRIET  TAYLOR  UPTON,  VICE  CHAIRMAN 
OF  THE  NATIONAL  REPUBLICAN  COMMITTEE,  WARREN,  OHIO. 

Mrs.  Upton.  Judge  Towner,  I  will  yield  my  time  to  you.  I  know  exactly  what 
the  committee  and  Congress  are  going  to  do  about  this,  and  I  can  not  argue  therefore- 
as  I  could  otherwise. 

Mr.  Towner.  I  am  sure,  Mrs.  Upton,  the  committee  would  like  to  hear  you,  if  yoa 
will  just  take  the  stand  for  a  moment. 

Mr.  Denison.  Did  I  understand  you  to  say  that  you  know  what  this  committee  is 
going  to  do? 

Mrs.  Upton.  No,  no;  not  at  all.  What  Congress  will  do.  I  don't  want  you  to 
frighten  me  by  looking  at  me  in  that  way  and  ask  me  a  question  in  that  way. 

Mr.  Denison.  I  hope  I  did  not  frighten  yoa.  There  is  one  thing  I  would  like  to 
know,  and  that  is  where  you  got  that  information? 

Mrs.  Upton.  I  will  tell  you  that  I  got  it  from  a  great  many  years'  experience  in 
Congress.  I  began  as  a  child  to  sit  l>y  my  father's  side  and  listen  through  just  such 
days  as  we  have  had  here;  and  I  have  found  out  that  men  treat  subjects  in  Congress 
a  great  deal  as  a  young  girl  treats  her  sweetheart.  They  flirt  with  it  a  long  time  and. 
then  come  around  and  pass  it. 

Mr.  Denison.  I  think  that  is  one  of  the  most  valuable  contributions,  after  all,  wt- 
have  had  in  the  coarse  of  the  hearings  on  this  bill . 

Mr.  Towner.  Mr.  Chairman,  I  will  call  Mrs.  Park. 

STATEMENT    OF   MRS.    MAUD    WOOD    PARK,    PRESIDENT    LEAGUE 
OF  WOMEN  VOTERS,  MUNSEY  BUILDING,  WASHINGTON,  D.   C. 

Mrs.  Park.  Mr.  Chairman  and  members  of  the  committee,  I  speak  representing  the- 
women's  committee  on  the  Sheppard-Towner  bill.  This  is  a  joint  committee  of  12" 
of  the  great  national  organizations  of  women  that  have  indorsed  this  bill.  Those- 
organizations,  Mr.  Chairman,  are  the  American  Child  Hygiene  Association;  the  Ameri- 
can Association  of  University  Women;  the  General  Federation  of  Women's  Clubs;  the 
Girls'  Friendly  Society  in  America,  which  is  an  Episcopal  organization;  the  National 
Congress  of  ilothers  and  Parent  and  Teachers  Association;  the  National  Consumers' 
League;  the  National  Council  of  Jewi-:h  Women;  the  National  Organization  of  Public 
Health  Nursing;  the  National  Federation  of  Business  and  Professional  Women; 
Women's  League  for  Peace  and  Freedom;  The  National  League  of  Women  Voters;  the 
National  Society  Daughters  of  the  American  Revolution;  the  National  Women's  Chris- 
tian Temperance  Union;  the  National  Women's  Trade  Union  League;  and  the  National 
Board  of  the  Young  Women's  Christian  Association. 

Mr.  Chairman,  those  organizations  had  hoped  not  to  take  the  time  of  your  com- 
mittee. We  had  asked  permission  to  file  a  joint  statement  as  to  our  reasons  for  advo- 
cating this  measure,  and  as  to  our  belief  that  the  administration  should  be  in  the  hand* 
of  the  Children's  Bureau,  but  several  things  have  been  said  during  the  course  of  the- 
hearings  that  have  made  it  seem  advisable  for  a  representative  of  those  various  organi- 
zations to  present  as  briefly  as  possible  four  points,  and  that  is  what  I  shall  try  to  do. 

First,  I  have  already  stated  to  you  the  organizations  which  are  working  actively 
for  this  measure.  Many  other  organizations  have  indorsed  it,  but  these  organizations 
are  represented  on  the  Sheppard-Towner  committee  of  women's  organizations. 

In  the  second  place  I  wish  to  speak  to  you  about  the  methods  by  which  the  indorse- 
ments of  these  organizations  are  obtained. 

In  the  third  place,  al^out  the  reasons  why  this  measure  seems  to  women  of  the  most 
urgent  importance.  , 


PUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  255 

And  in  the  fourth  place,  I  wi'^h  to  state  briefly  why  we  believe  that  the  adminis- 
tration should  be  in  the  hands  of  the  Children's  IJureau. 

Several  rather  mistaken  statements  have  been  made  with,  regard  to  the  methods 
of  indoi-sement  of  the  women's  orsfiini/ations.  Yesterday  a  lady  from  my  own  State, 
Mrs.  Putnam,  who  tjave  an  a(lmiral)Iy  clear  statement  of  her  reasons  for  opposing 
the  present  bill,  said  that  she  had  understood  tliat  the  I'^lorida  State  1^'ederation  of 
Women's  Clubs  was  not  in  favor  of  this  measure,  last  night  I  telegra])hed  to  Morida, 
and  since  I  came  into  the  room  this  afternoon  I  have  received  this  ofhcial  telegram, 
and  I  am  sure  the  lady  who  made  that  statement  yesterday  will  be  glad  to  have  the 
correct  information  in  the  matter: 

Mrs.  M.AUi)  Wood  P.vrk, 

President  League  of  Women  Voters, 

Munsey  Building,  Washington,  D.  C: 
Florida  federation  indorsed    Sheppard-Towner   bill   annual   meeting  November. 
1920.  and  at  two  ])oard  meetings  since.     Clubs  also  studied  and  indorsed.     Officers 
spoke  all  through  State  of  Florida.     Women  most  m-gent  regarding  passage  of  bill. 

Eliz.vbeth  Skinner. 
Vice  President  at  Large,  Florida  Federation  Woinen's  Clubs. 

,  With  regard  to  the  methods  by  which  these  indorsements  are  secured,  I  wish  to 
illustrate,  if  I  may,  by  the  method  adopted  by  tlie  organization  of  which  I  am  presi- 
dent, the  National  League  of  Women  Voters.  I  believe  that  the  methods  of  the 
other  organizations  in  obtaining  their  indorsements  are  very  much  like  our  own. 
We  have  a  committee  on  child  welfare,  which  is  composed  of  a  chairman,  an  expert 
upon  that  question,  and  a  member  from  each  one  of  oiu-  State  organizations  which 
choose  to  appoint  a  member  upon  that  committee.  We  have  an  organization  in  every 
State  in  the  Union.  That  committee  studies  questions  of  child  welfare  dining  the 
year,  and  foiu"  months  before  our  convention  it  makes  recommendation  to  our  national 
board  of  measures  for  legislative  support  on  the  siibiect  of  child  welfare.  Those 
recommendations  are  made  to  the  board,  and  at  least  two  months  before  our  annual 
convention  the  board  is  required  to  send  out  to  all  our  State  organizations  the  meas- 
ures that  are  to  be  brought  up  for  indorsement  by  these  various  committees  at  the 
convention.  We  request  the  presidents  of  our  State  organizations  to  have  these 
various  measiu-es  discussed  on  all  sides.  We  supply  them  with  copies  of  the  bills. 
We  have  been  at  great  expense  to  have  copies  of  the  bills  which  we  indorsed  printed 
or  mimeographed  in  order  to  make  sure  that  they  are  given  in  large  numbers  for  the 
study  of  these  various  measiu'es  before  indorsement  comes. 

Then  the  State  associations  are  at  liberty,  if  they  choose,  to  send  their  delegates 
to  the  convention  instructed  as  to  how  to  vote  on  the  question. 

On  the  day  preceding  the  convention  an  all-day  conference  is  held  by  each  one  of 
our  committees,  which  presents  legislative  measures,  but  the  all-day  conference  can 
not  add  anything  to  the  program  that  has  preAdousIy  been  sent  out,  except  by  three- 
fourths  vote  of  the  members  present. 

Then  the  conference  committee  reports  to  the  convention.  All  the  opportunity 
desired  is  given  for  discussion  pro  and  con  in  the  convention.  If  the  measure  is  a  new 
measure,  one  which  has  not  pre\T.ously  been  before  the  organization,  it  requires  at 
least  a  two-thirds  vote  of  the  delegates  of  the  association  present  and  voting  to  bring 
about  the  indorsement. 

That  is  the  way  in  which  our  organization  indorsed  the  Sheppard-Towner  bill,  and 
I  offer  that  as  evidence  that  the  indorsements  are  not  snap  judgments  of  women 
who  are  not  informed  as  to  the  measure  which  they  have  indorsed. 

With  regard  to  the  methods  of  work  of  the  women's  joint  committee,  we  have  a 
representative  of  each  one  of  the  associations  on  the  committee.  Each  of  those  rep- 
resentatiA'es  informs  her  association  as  to  the  state  of  affairs,  the  proposed  amend- 
ments to  the  bill,  and  so  on,  and  we  work  together  in  order  to  prevent  duplication, 
and  to  give  you  gentlemen  in  Congress  as  little  trouble  as  possible  on  the  subject. 

In  order  that  you  may  understand  how  interested  we  are  in  this  matter,  let  me  say 
that  this  measure  has  received  the  largest  indorsement  of  any  measure  before  the 
Congress  from  the  great  national  organizations  of  women.  I  msh  to  state  further  that 
I  think  the  names  of  the  associations  that  I  have  quoted  are  a  sufficient  answer  to 
some  of  the  objections  that  have  been  brought  forward  against  the  bill  as  a  subtle 
measure  to  advance  birth  control,  socialism,  or  bolshe\T.sm.  I  ask  whether  you  think 
that  the  Young  Women's  Christian  Association  or  the  National  Women's  Christian 
Temperance  Union,  or  the  General  Federation  of  Women's  Clubs,  or  any  of  these 
other  organizations,  are  likely  to  support  any  of  those  things  that  the  opponents  of  the 
measure  have  said  the  supporters  advocate? 


256  PUBLIC  PROTECTION   OF   MATEEFITY  AND  INFANCY. 

With  regard  to  the  names  that  were  quoted  by  Mr.  Newton  and  that  I  understand 
were  used  at  the  hearing  yesterday,  let  me  say  that  the  statement  about  Dr.  Anna 
Howard  Shaw  is,  I  believe,  a  part  of  a  series  of  statements  which  were  attributed  to 
her  during  her  lifetime,  and  which  were  emphatically  denied  by  her  as  never  having 
been  made  in  any  such  form.  At  that  time  the  attack  upon  her  was  dropped,  because 
her  denial  was  sufficient.  I  am  sorry  to  observe  that  that  attack  has  been  renewed 
since  her  death,  when  she  is  not  here  herself  to  repudiate  with  her  wonderful  elo-- 
quence  any  such  statements  as  were  attributed  to  her.  I  have  not  at  this  moment, 
because  I  did  not  expect  that  anybody  would  revive  a  statement  of  that  sort,  in  a 
hearing  here,  the  exact  form  in  which  she  did  repudiate  those  statements,  but  by 
hunting  through  the  files  of  the  organization  I  can  find  it. 

With  regard  to  those  other  names  that  have  been  used,  let  me  say  that  I  have  infor- 
mation about  the  work  that  has  been  done  for  this  bill  in  the  last  Congress  and  in  the 
present  Congress.  I  have  been  a  member  of  this  women's  joint  committee.  I  am 
myself  the  elected  chairman  of  the  women's  joint  congressional  committee,  and  I 
am  entirely  familiar  with  the  personnel  of  the  women  who  have  worked  in  Washing- 
ton and  out  through  the  country  for  this  measure.  I  am  not  aware  that  any  of  the 
ladies  whose  names  Mr.  Newton  has  mentioned  have  advocated  this  measure. 

I  understand  that  a  periodical  was  quoted  from  yesterday,  while  I  was  in  the  Sen- 
ate gallery,  to  prove  that  the  organizations  which  indorse  this  measure  support  birth 
control.  Let  me  say  that  that  periodical  is  the  official  organ  of  an  association  which 
has  never  indorsed  the  measure,  so  that  there  is  absolutely  no  connection  there. 

With  regard  to  my  third  point,  why  this  matter  seems  so  urgent  to  women,  I  wish 
to  remind  the  gentlemen  that,  after  all,  the  immediate  experience  of  child  bearing 
must  be  a  woman's  experience  and  that  the  experience  of  child  rearing  is  largely  a 
woman's  experience.  We  agree  perfectly  with  those  witnesses  who  have  already 
said  that  it  is  far  more  than  a  woman's  question.  We  appreciate  deeply  the  interest 
and  the  support  that  husbands  and  fathers  who  care  for  their  own  families  and  who 
have  a  fatherly  heart  toward  children  all  over  the  world  are  anxious  to  give  a  measure 
of  this  kind.  But  when  it  does  come  down  to  the  final  analysis,  I  am  sure  you  will  / 
agree  that  the  immediate  connection  is  a  connection  with  women  and  their  normal  ^ 
experiences  in  life. 

We  do  not  agree  with  one  of  the  opponents  of  the  measure  in  the  Congress  who  told 
one  of  our  representatives  that  he  thought  that  maternity,  infancy,  and  all  such  diseases 
ought  to  be  in  the  hands  of  the  Public  Health  Service.  We  do  not  regard  maternity 
and  infancy  exactly  in  the  light  of  a  disease.  We  believe  that  it  is  a  normal  expe- 
rience of  human  life  and  an  experience  of  paramount  concern  to  women,  we  in  whose 
hands  the  first  responsibility  for  the  conservation  of  human  life  has  been  placed. 
That  is  why  a  measure  which  is  designed  to  save  human  life  is  a  measure  which  must 
be  of  the  most  urgent  concern  to  women. 

With  regard  to  my  fourth  point,  why  we  believe  that  the  administration  should  be 
in  the  hands  of  the  Children's  Bureau.  I  can  only  state  to  you  very  hastily  what  the 
experience  of  the  women  of  this  country  has  been  with  the  work  oi  the  Children's 
Bureau.  That  bureau  has  the  confidence  of  women  all  over  the  country.  They  are 
familiar  with  it.  When  the  bureau  was  created  by  the  Congress,  and  when  Miss 
Lathrop  was  appointed  by  President  Taft  as  its  chief  at  the  time  of  its  creation, 
women  following  social  work  all  over  the  country  rejoiced  that  we  were  to  have  a 
bureau  dealing  primarily  with  children's  interests  and  that  we  were  to  have  some  one 
at  its  head  who  was  known  to  be  an  authority  on  great  social  questions.  Ever  since 
that  time  the  women  have  been  following  the  work  of  the  Children's  Bureau  with 
great  interest  and  great  pride.  In  the  "children's  year"  work  during  the  war  orga- 
nizations of  women  joined  with  the  officials  of  the  Children's  Bureau  to  make  that 
experiment  a  success,  and  the  work  of  the  bureau  is  known  and  respected  in  every 
State  in  the  country. 

As  an  officer  of  my  own  association,  I  was  this  last  year  in  29  of  the  48  States  of  the 
Union,  and  I  found  in  every  one  of  those  States  the  greatest  interest  among  women  in 
this  bill,  and  the  most  earnest  hope  that  the  administration  would  be  in  the  hands 
of  the  Children's  Bureau,  because  women  knew  about  the  work  of  this  bureau,  and 
because  they  felt  that  a  bureau  which  specialized  in  the  welfare  of  children  would 
be  able  to  give  a  single-minded  attention  to  the  administration  which  a  bureau  charged 
with  the  heavy  responsibility  that  the  Public  Health  Service  has  for  preventing 
the  spread  of  contagious  diseases,  and  so  on,  would  not  be  so  likely  to  be  able  to  give. 

Moreover,  on  the  point  of  administration  that  has  been  so  frequently  raised  as  to 
Avhether  a  medical  person  ought  not  to  be  at  the  head  of  this  Work  because  it  is  in 
part  medical  work,  we,  the  representatives  of  the  women's  organizations,  believe 
that  the  administrative  office  is  not  an  office  that  requires  a  technical  expert  training     ] 
in  any  one  branch  of  the  work  to  be  done. 


publk;  protrctton  oy  materxtty  axd  tnfaxcy,         257 

Perhaps  I  can  best  illustrate  that  point  l)y  a  joke  that  someVjody  told  mo  the  present 
Secretary  of  War  made  recently.  I  am  told  that  the  present  S(scretary  of  War  is  in 
the  habit  of  8ayin.<>;  humorously  that  he  is  a  l)anker  by  vocation,  a  farmer  by  avocation, 
and  a  sailor  by  eduftation,  but  that  the  portfolio  which  has  been  jjiven  him  is  the 
portfolio  of  a  department  in  which  he  has  had  no  practical  experience  whatever. 
The  answer,  very  naturally,  is  that  we  all  recoj,'nize  that  in  administrative  oflices 
general  administrative  ability,  (juickness  to  see  the  various  aspects  of  a  question, 
is  the  thinjj  that  is  n^quired  in  the  administrative  h(!ad  of  work  Avhich  enlists  a  great 
many  different  factors. 

No  administrator  would  be  a  good  administrator  who,  in  a  ])roblem  such  as  this 
bill  isintf'ndt'd  to  meet,  did  not  take  expert  advice  on  th(>  medical  side,  expert  advice 
on  the  educational  side,  expert  advice  on  the  side  of  the  social  work.  We  believe 
that  the  Children's  Hureau  is  prepared  to  give  the  sort  of  all-around  administrative 
attention  to  this  ((uestion  which  will  neglect  no  one  of  the  imjjortant  aspects  of  the 
work,  and  yet  will  not  tend  to  emjjhaaize  one  aspect  at  the  expense  of  anoth(;r. 

I  want  to  add  just  a  brief  word  of  jKirsonal  experience,  because  sometimes  we  are 
accused  of  not  having  had  any  practical  experience  in  these  matters.  For  11  years 
of  my  life  I  have  lived  in  what  is  called  the  "slum"  section  of  two  great  cities  of  this 
country.  I  have  livcnl  9  years  in  two  tenement  houses  in  my  own  city  of  Boston, 
very  near  the  South  Station  in  the  section  that  stretches  out  from  it.  I  lived  a  year, 
after  the  lire,  in  a  settlement  house  in  San  Francisco. 

I  feel  obliged  to  make  this  person;'J  explanation  because  there  has  been  a  very 
systematic  attempt  to  discredit  the  representatives  of  the  women's  organizations 
by  saying  that  they  are  seeking  positions  under  the  Government,  or  that  they  have 
been  in  the  service  of  the  Children's  Bureau,  or  something  of  that  sort.  I  did  that 
work  without  salary,  as  I  have  done  all  my  work  in  connection  with  any  measure 
which  I  have  worked  for  before  the  Congress  of  the  United  States.  I  apologize  for 
making  any  personal  reference  of  that  sort.  I  do  it  as  I  said  only  in  answer  to  the 
Bystematic  attempt  to  discredit  the  workers  in  this  cause. 

In  my  work,  in  tenement  districts — although  I  am  not  a  trained  nurse  or  profes- 
sional social  worker — I  did  come  to  know  my  neighbors  in  the  adjoining  tenements, 
know  the  needs  of  their  large  families,  and  to  realize  what  it  was  that  gave  them  most 
assistance  during  periods  such  as  are  intended  to  be  covered  by  a  measure  of  this 
kind.  I  know  that  it  is  not  purely  medical  assistance  that  they  need,  it  is  not  purely 
trained-nursing  assistance  that  they  need — it  is  the  kind  of  assistance  that  knows  how 
to  summon  the  cooperation  of  the  special  forces  that  may  be  needed  at  the  particular 
moment.  1  have  seen  this  need  illustrated  over  and  over  in  the  crowded  sections 
of  great  cities. 

I  have  received  a  letter,  which  I  will  not  take  your  time  to  read,  from  the  Instruc- 
tive District  Nursing  Association,  through  its  director  in  the  city  of  Boston,  and  I 
ask  leave  to  file  that  as  a  further  illustration  of  the  belief  that  the  great  majority  of 
persons  who  are  dealing  intimately  with  these  problems  have  of  the  need  of  some 
such  measure  as  the  Sheppard-Towner  bill,  under  the  administration  of  such  a  body 
as  we  believe  the  Children's  Bureau  to  be. 

(The  letter  presented  by  Mrs.  Park  is  here  printed  in  full,  as  follows:) 

Instructive   District  Nursing  Association, 

Boston,  Mass.,  July  18,  1921. 
Mrs.  L.  Brown, 

National  League  of  Women  Voters,  Washington,  D.  C 

My  Dear  Mrs.  Brown:  I  am  sending  herewith  a  brief  statement  regarding  the 
Sheppard-Towner  bill. 

I  am  strongly  in  favor  of  the  Sheppard-Towner  bill,  because  intimate  public-health, 
nursing  experience  during  the  past  nine  years  has  convinced  me  that  through  such 
measures  as  are  advocated  in  the  bill  an  immediate  reduction  in  maternal  and  infant 
mortality  mil  be  assured. 

In  the  city  of  Boston  in  1921  there  were  over  20,000  births:  25  per  cent  of  these 
births  came  under  the  care  of  the  Instructive  District  Nursing  Association. 

Maternal  mortality:  Instructive  District  Nursing  Association,  2.1  per  1,000  cases; 
city  of  Boston,  7.6  per  1,000  cases.  Sixty-three  per  cent  of  these  cases  received  pre- 
natal care  also. 

Mortality  of  infants  up  to  two  weeks:  Instructive  District  Nursing  Aeecciation, 
13.37;  city  of  Boston,  37. 

Reduction  maternal  mortality  through  prenatal  and  maternity  care,  72  per  cent. 

Reduction  infant  mortality,  G4  per  cent. 

This  prenatal  care  consists  in  instruction  given  by  public-health  nurses. 

74654-^:iJ 17 


258  PUBLIC   PEOTECTION    OF   MATEEOSriTY  AND   TaSTFAlSTCY. 

The  figures  quoted  are  similar  to  the  results  of  studies  made  over  a  period  covering 
the  past  nine  years  and  to  one  intimately  connected  with  the  work,  leave  no  room  for 
doubt  that  the  comparatively  simple  measures  advocated  by  the  Sheppard-Towne 
bill  would  save  many  thousand  lives  yearly. 
Sincerely,  yours, 

Mary  Beard,  Director. 

Mr.  Denison.  Do  you  know  anything  about  this  publication  called  The  Suffragist? 

Mrs.  Park.  I  know  that  it  was  the  official  organ  of  the  association  called  the  National 
Woman's  Party.     It  has  been,  and  I  think  it  still  is. 

Mr.  Denison.  Are  you  connected  in  any  way  with  that  party? 

Mrs.  Park.  I  am  not  and  never  have  been.  And  that  party  is  not  one  of  the  asso- 
ciations which  has  indorsed  this  bill. 

Mr.  Denison.  It  has  not  indorsed  the  bill? 

Mrs.  Park.  No;  not  to  my  knowledge.  It  is  not  one  of  the  associations  represented 
on  the  Women's  Joint  Committee. 

Mr.  Barkley  (presiding).  If  there  are  no  further  questions,  the  committee  is  very 
much  obliged,  Mrs.  Park,  for  your  statement. 

The  Chairman.  Judge  Towner. 

STATEMENT  OF  HON.  HORACE  M.  TOWNER,  A  REPRESENTATIVE 
IN  CONGRESS  FROM  THE  STATE  OF  IOWA. 

Mr.  Towner.  Mr.  Chairman  and  gentlemen  of  the  Committee,  I  want  first  of  all  to 
thank  the  committee  for  myself — and  I  am  sure  that  I  speak  for  those  who  are  the 
proponents  of  this  bill  and  have  knowledge  of  the  conditions — I  want  to  thank  the 
chairman  and  the  members  of  the  committee  for  the  very  careful  attention  that  has 
been  given  to  this  bill,  and  I  want  to  say  that  never  have  I  seen  any  committee  give 
better  attention  or  more  intelligent  interest  than  has  been  given  by  the  members  of 
this  committee,  and  I  never  have  seen  so  good  an  attendance  upon  any  hearing.  ^ 

Gentlemen,  it  is  just  simply  impossible  for  me  to  do  what  I  contemplated  doing  in  \ 
the  short  time  remaining,  and  I  shall  only  call  your  attention  to  a  very  few  things. 
It  is  always  a  good  idea  to  get  back  to  origins  and  fundamentals  sometimes.  When 
the  Public  Health  Service  was  established,  the  law  provided  that  it  "may  study  and 
investigate  the  diseases  of  man,  including  sanitation,  and  may  issue  inform.ation." 
That  is  the  substance  of  the  powers  that  were  conferred  upon  the  Public  Health  Ser- 
vice. Subsequently,  and  carried  in  the  sundry  civil  appropriation  bill  from  time  to 
time,  a  provision  was  adopted  that  the  Public  Health  Service  may  make  special 
studies  of  and  demonstration  work  in  rural  sanitation  contingent  upon  like  appro- 
priations being  made  by  the  State.  Now  I  call  your  attention  to  these  provisions 
to  show  that  there  was  no  particular  duty  imposed  upon  the  general  health  service ' 
for  the  purpose  of  studying  matters  pertaining  to  maternity  and  child  welfare.  Then 
the  law  was  passed  creating  the  Children's  Bureau. 

It  is  a  singular  fact — I  think  a  significant  fact — that  maternity  and  child  welfare 
work  Avhich  are  now  referred  to  as  properly  belonging  to  the  Public  Health  Ser'iAce 
by  the  opponents  of  this  bill — it  is  a  significant  fact  that  when  the  Children's  Bureau 
was  established  the  very  tilings  that  are  contained  in  this  bill  and  made  the  object 
and  purposes  of  this  bill  were  directly  and  specifically  given,  not  to  the  Public  Health 
Service,  bat  given  to  a  new  and  an  independent  bureau  to  be  known  as  the  Children's 
Bureau.  What  was  in  the  minds  of  Congress  when  they  did  that?  Let  xis  see 
[reading] : 

' '  The  said  bureau  shall  investigate  and  report  to  said  department  upon  all  mattei  s 
pertaining  to  the  welfare  of  children  and  child  life  among  all  classes  of  our  people, 
and  shall  especially  investigate  the  questions  of  infant  mortality,  the  birth  rate, 
orphanage,  juvenile  courts,  desertions,  dangerous  occupations,  accidents  and  dis- 
eases of  children,  employment,  legislation  affecting  children  in  the  several  States 
and  Territories." 

So  that  this  particular  thing  could  not  have  been  any  more  distinctly  specified  than 
it  was  in  this  bill  as  being  the  duty  of  the  Children's  Bureau  to  investigate  and  make 
report. 

Mind  you,  gentlemen,  there  is  no  more  power  given  to  the  Public  Health  work 
than  there  is  to  the  Children's  Bureau  with  regard  to  these  matters.  In  both  cases 
it  was  to  investigate  and  report  only,  and  yet  the  specific  work  that  it  is  intended  by 
this  bill  to  promote  was  by  the  Congress  of  the  United  States  connected  to  the  Cliil- 
dren's  Bureau  and  not  to  the  Public  Health  Service.  Now  if  you  do  not  continue  it 
with  the  Children's  Bm-eau  you  directly  repudiate  the  act  of  Congress.  You  would  / 
say,  there  is  no  need  for  a  Children's  Bureau,  the  Public  Health  Service  can  do  the  '' 
work.     You  would  say  that  all  of  these  things  that  are  provided  in  the  bill  and  that 


PUBLIC!   PROTECTION   OF    MATERNITY   AND   INFANCY.  259 

are  in-nvidod  in  the  act  creating  t]i(!  Children's  Bureau  .should  be  transferred  lo  tin; 
Public  Health  Service. 

Now,  gentlemen  of  the  committee,  there  is  no  one  that  has  a  higher  admiration 
for  the  Public  Health  Service  of  the  United  States  than  I  have.  There  is  no  one  that 
recognizes  more  than  I  do  the  s])lendid  service  which  they  have  rendered  to  tliis 
country.  But  Congress  has  said,  and  has  said  just  as  strongly  as  coidd  po8sil)ly  be 
said,  there  should  l)e  .someliody  else  that  should  be  taken  into  consideration  with 
regard  to  matters  of  tliis  character. 

It  has  been  said  here  that  (he  (juestion  of  maternity  and  the  child  welfare  is  a 
question  ])ertaining  not  only  to  women  but  to  ni(»n.  1  have  an  idea,  genthimen, 
that  when  Congress  enacted  this  law  they  thought  that  it  was  not  wise  nor  best  that 
the  exclu.siv(»  investigation,  or  the  exclu.sive  governmental  activity,  that  the  exch^sive 
governmental  hel])  should  be  given  by  men  in  questions  of  this  kind.  And  so  we 
have  in  o]ieration  the  Public  Health  Service  and  the  Children's  Bureau,  the  one 
under  the  direction  of  men,  the  other  under  the  direction  of  women,  and  there  is  no 
reason  in  the  world  why  they  should  iu)t  and  can  not  work  together  liarmonionsly. 
There  is  no  reason  in  the  world  why  they  can  not  do  just  what  has  been  said  by  the 
Public  Health  Service  rei)resentx'(l  here  yesterday,  when  they  stated  before  this 
committee  that  there  was  no  overlapiiing  of  the  work,  that  both  of  them  combined 
could  not  satisfy  the  demand  and  could  not  cover  the  territory. 

Mr.  Denison.  While  you  are  on  that  T  want  to  ask  you :  Does  the  act  fix  any  limita- 
tions as  to  who  should  be  a])])ointed  the  head  of  the  Children's  Bureau,  whether  it 
should  be  a  man  or  a  woman? 

Mr.  Towner.  No;  but  unquestionably  it  was  in  the  minds  of  the  legislators,  as  the 
gentleman  will  see  i)y  the  debate,  that  the  Children's  Bureau  shoidd  be  a  woman's 
dejiartnient,  and  its  administration  and  personnel  has  l)een  such  from  the  beginning. 
It  was  a:<ked  for  by  the  women  and  has  ever  since  been  considered  their  particular 
interest. 

Now,  gentlemen,  we  have  the  approval  of  this  work  by  the  Public  Health  Service. 
They  say  it  is  a  necessary  work.  We  have  the  demonstration  coming  from  all  over 
the  United  States  of  both  the  need  and  the  adequateness  of  the  remedy.  They  all 
say  it  i'^  a  beneficent  work.  They  all  say  it  is  necessary.  This  hearing  has  demon- 
strated beyond  the  possibility  of  any  question  the  need  of  this  sort  of  work,  of  its 
practicability,  of  the  fact  that  there  is  not  necessarily  any  ground  of  antagonism 
between  the  Pu1)lic  Health  Service  and  the  work  of  the  Children's  Bureau,  as  exempli- 
fied in  the  law  or  as  set  out  here  in  the  l)ill  which  we  are  proposing.  There  is  not  any 
question  but  what  they  can  and  %^dll  work  harmoniously  together. 

The  testimony  of  Dr.  Baker  showed  that  originally  there  was  some  antagonism 
among  the  physicians  in  the  city  of  New  York  regarding  the  work,  but  the  testimony 
also  shows  that  after  they  understood  it  they  approved  it  and  now  give  it  their  official 
and  general  sanction.  It  is  only  when  it  is  naisunderstood  that  it  is  made  to  appear 
antagonistic.  WTierever  the  work  has  been  done  there  has  never  been  one  single 
instance  shown  of  any  antagonism  between  the  workers  as  to  which  should  do  this 
or  that  particular  thing.  There  is  so  much  to  do  there  is  work  for  all.  That  is  shown 
conclusively  by  the  statements  made  not  only  by  the  proponents  but  also  by  the 
o})ponents  to  the  bill  and  by  the  statement  that  I  read  into  the  record  a  little  while 
ago. 

I  can  not  blame  the  Public  Health  Service  for  desiring  to  have  the  superintendence 
of  this  great  work.  Of  course  they  would  like  to  have  it.  I  have  not  the  slightest 
doubt — in  fact,  I  know  as  a  matter  of  fact — that  when  this  Children's  Bureau  was 
created  they  desired  that  it  should  be  placed  under  their  superintendence.  The 
matter  was  fully  considered,  and  it  was  thought  that  greater  intere-'t  and  greater  sup- 
port for  the  particular  Avork  intended  could  be  ol)tained  by  the  creation  of  a  bureau 
whose  identity  would  not  be  merged  with  a  branch  of  the  service  having  other  and 
what  it  considered  more  important  matters.  And  it  was  decided  that  the  work  of 
the  Children's  Bureau  need  not  duplicate  the  work  of  the  Public  Health  Ser-vdce, 
but  rather  supplement  it.  It  was  decided  that  women  should  be  given  a  part  in  the 
work  in  which  they  were  so  deeply  interested.  To  merge  them  now  under  the  Public 
Health  Service  would  reverse  the  action  taken  and  prove  disastrous  all  around. 

I  do  not  blame  the  Public  Health  Service  for  desiring  to  have  this  under  their 
control.  But  I  do  know  that  if  sueh  action  is  taken  millions  and  millions  of  women 
of  the  United  States  of  America  will  feel  that  there  had  lieen  taken  from  them  their 
proper  share  of  respon-ibility  and  part  in  this  work.  There  is  no  possi1)le  question 
Avith  regard  to  that,  ^\^ly,  the  very  act  itself  was  created  for  that  purpose.  Shall 
we  repudiate  that  action  of  Congress  now?  Has  anything  happened  that  shows  that 
the  t'hildren's  Bureau  ha-^  failed  in  the  work  committed  to  it?  Has  anything  happened 
that  will  show  that  the  Children's  Bureau  is  not  fit  to  l)e  entrusted  with  this  work? 


/i 


260  PUBLIC   PEOTECTIOlSr    OF   MATERNITY  AND   INFANCY. 

I  know  that  the  Children's  Bureau  has  enemies.  I  know  that  they  desire,  for  some 
particular  reasons  which  have  only  been  partially  disclosed,  that  the  Children's 
Bureau  should  go  out  of  existence.  It  has  enemies,  of  course,  as  every  good  institu- 
tion in  the  United  States  has  enemies.  But  there  are  millions  of  people,  people  who 
know  its  work,  who  believe  that  there  is  not  another  bureau  of  the  Government  that 
ought  to  be  sustained,  or  that  deserves  being  sustained  more  than  the  Children's 
Bureau.  Do  not  think,  gentlemen,  that  this  is  a  minor  question  that  mav  be  deter- 
mined cursorily.  It  is  being  talked  about  at  a  million  firesides  of  this  Nation.  The 
inquiry  will  be  made  why  the  women  of  America  should  not  have  a  part  in  the  con- 
sideration of  maternity  and  infant  mortality. 

Mr.  Rayburn.  Would  it  make  any  difference  if  a  woman  were  placed  at  the  head 
of  this  particular  di^dsion,  as  to  whether  or  not  it  was  under  the  Public  Health  Service 
or  whether  it  was  in  the  Department  of  Labor? 

Mr.  Towner.  Yes,  Mr.  Rayburn.  I  do  not  think  you  can  get  Congress  or  the  people 
of  the  United  States  to  approve  of  a  proposition  that  will  consolidate  this  work,  and 
place  its  direction  and  control  exclusively  with  the  Public  Health  Service.  That 
would  make  it  an  all-man's  work.  Why  was  it  not  originally  placed  in  the  Public 
Health  Department?  The  Public  Health  Service  asked  that  it  be  given  them.  They 
thought  that  it  ought  to  have  been  originally  placed  there.  But  the  people  of  the 
United  States  do  not  think  so.  The  people  of  the  United  States,  through  their  Repre- 
sentatives in  Congress,  have  determined  that  question  once,  and  there  is  no  indication 
of  a  repudiation  of  it  by  any  means. 

And  now  let  us  see  what  is  the  final  result  of  these  contentions.  It  has  been  given 
to  you,  and  it  only  needs  your  approval  to  be  carried  into  effect.  The  people  im- 
mediately interested  have  finally  adi'usted  the  matters  in  controversy  between  them. 
This  morning  these  people  got  together  and  this  is  what  they  did.  The  Secretary  of 
the  Treasury,  which  has  control  of  the  Public  Health  Department,  wrote  a  letter  to 
the  Sea-etary  of  I^abor,  which  has  control  of  the  Children's  Bureau,  and  this  is  what 
it  BajB: 

"  In  view  of  the  conference  held  in  your  office  this  morning,  at  which  were  present 
the  Secretary  of  Labor,  the  Assistant  Secretary  of  the  Treasury,  acting  for  the  Sec- 
retary, who  is  out  of  the  city;  the  Chief  of  the  Children's  Bureau,  and  the  Surgeon 
General  of  the  Public  Health  Service,  I  am  glad  to  assure  you  that  there  is  no  objec- 
tion on  the  part  of  the  Treasury  Department  to  the  administrative  features  of  the 
Sheppard-Towner  bill  now  before  the  Interstate  and  Foreign  Commerce  Committee  of 
the  House  of  Representatives.  Should  the  bill  be  passed,  the  Public  Health  Service 
will  render  every  assistance  possible  to  the  Children's  Bureau." 

Now,  gentlemen,  what  better  evidence  of  the  fact  that  there  can  be  cooperative  and 
harmonious  work  done  in  these  departments  than  that?  "\\Tiat  better  e^ddence  could 
you  want  that  when  you  put  in  this  Children's  Bureau  the  work  which  is  contem- 
plated in  this  act  you  are  doing  that  which  will  meet  with  the  largest  general  accept- 
ance and  secure  the  best  possible  execution  of  the  law? 

Changes  have  been  discussed  and  many  of  them  made  in  the  bill.  I  wish  I  had 
time  to  go  throiigh  with  these  varioiis  amendments  that  have  been  adopted  by  the 
Senate.  I  do  not  need  to  talk  to  you  about  them.  You  are  intelligent  and  expe- 
rienced men.  Consider  them.  But  on  these  fundamental  propositions  I  ask  you  not 
to  change  them,  because  I  do  not  believe  that  it  will  meet  with  the  approval  of  the 
country,  and  I  believe  that  you  ought  not  to,  on  the  merits  of  the  proposition. 

Why  can  not  they  do  what  has  been  done  in  New  York  City,  where  there  has  been 
the  utmost  harmony  between  the  persons  who  have  had  charge  of  this  child-welfare 
work  and  the  physicians  and  the  health  department?  Why  does  not  Miss  Lathrop 
come  here  and  complain  because  of  the  fact  that  the  administration  in  the  States, 
under  the  provisions  of  the  bill,  is  in  the  Public  Health  Department? 

Of  course,  there  is  medical  work.  There  is  medical  advice,  there  is  medical  assist- 
ance needed  in  the  execution  of  this  law,  and  it  is  provided  in  the  bill  that  it  shall 
be  given.     And  if  it  does  not,  change  it. 

Some  gentlemen  seem  to  feel  that  there  is  too  much  power  given  to  the  Children's 
Bureau  in  determining  how,  when,  and  where  and  under  what  circumstances  these 
appropriations  shall  be  approved.    Well,  gentlemen,  that  is  for  you  to  say.  _  There  is 
nothing  necessary  except  to  see  that  the  money  shall  be  used  for  the  purposes  intended. 
Now,  if  you  can  make  that  more  clear,  do  so.     We  will  have  no  objections.     I  will 
support  the  bill  mth  any  change  or  amendments  that  you  think  may  be  necessary  to 
guard  it  against  any  possible  exercise  of  autocratic  power  to  force  upon  the  States 
something  that  they  do  not  want.     It  is  not  the  object  and  purpose  of  this  bill  to  do  , 
anything  except  to  act  in  harmony  with  the  States  in  regard  to  this  work.     It  has  no  'j 
other  object  and  pux-pose  than  to  stimulate  them  to  activity  and  to  assist  the  backward'^ 
States  to  bring  up  the  standard  to  where  it  ought  to  be. 


PUBLIC  PROTECTION   OF   MATERNITY  AND  INFANCY.  261 

This  is  a  great  work,  a  humanitarian  work  that  ought  to  appeal  to  everybody,  and  it 
does.  Everybody  api)roves  of  it  when  they  understand  it.  I  Jiave  been  surprised  at 
the  unanimity  tliat  lias  been  expressed  ))y  both  tlie  supi)orters  and  the  opponents 
this  Ijill  witli  regard  to  the  necessity  of  this  work,  of  its  efficiency,  of  what  it  accom- 
plishes wherever  it  is  undertaken.  Even  those  who  are  opposed  to  the  bill  admit  that 
if  under  otlier  circumstance.'^  it  were  administered  or  could  l)e  administered,  it  would 
be  better  than  it  would  l)e  under  some  other  circumstances;  but  that  is  as  far  as  the 
objection  goes.  So  tliat  after  all  there  is  nothing  that  can  not  be  harmonized  and 
carry  out  tlie  purpose  and  intent  of  those  who  desire  tlie  passage  of  tliis  bill.  And  if 
that  is  worth  while,  if  it  is  worthy  of  your  a]jproval,  if  there  is  a  measure  of  necessity  in 
it,  then  it  occurs  to  me  you  ought  not  to  have  any  very  great  difficulty  in  arriving  at  a 
conclusion  with  regard  to  what  it  ought  to  be. 

I  ask  your  careful  consideration  of  the  terms  of  the  bill.  I  ask  your  careful  consider- 
ation of" the  amendments  that  the  Senate  has  proposed.  Some  of  those  amendments 
I  would  dislike  to  have  you  ai)prove.  One  of  the  amendments  allows  only  $1,000,000 
a  year  after  the  fh-st  initial  appropriation  of  $1,480,000.  I  think  the  appropriation  is 
altogether  too  small,  too  small  as  it  is.  I  hope  you  gentlemen  will  feel  that  you  are 
justified  in  continuing  the  original  provision  of  the  bill,  which  would  allow  the  §480,000 
to  be  continued  and  the  $1,000,001)  to  be  also  apportioned  among  the  States. 

Now,  if  there  are  any  questions  that  you  gentlemen  would  desire  to  ask  in  the  three 
or  four  minutes  tliat  I  have  left,  I  would  be  very  glad  to  answer. 

Mr.  Hawes.  How  many  amendments  were  made  to  the  bill? 

Mr.  Towner.  There  were  quite  a  number  of  them,  Mr.  Hawes. 

Mr.  Hawes.  I  wanted  to  know  how  many,  if  you  have  that  information. 

Mr.  Towner.  I  will  be  glad  to  show  them  to  you.  Most  of  them  are  merely  verbal 
changes.  The  one  which  I  called  attention  to  is  quite  an  important  change,  as  I  sug- 
gested. They  also  changed  the  word  "authorized"  to  "directed"  with  regard  to  the 
formation  of  the  ad^dsory  committee.  I  do  not  consider  that  as  particularly  important. 
There  are  some  other  changes  that  are  somewhat  important,  none  of  which,  however, 
I  would  oppose  if  they  meet  with  the  approval  of  the  committee,  except  the  one  that  I 
have  called  attention  to. 

Mr.  Denison.  May  I  ask  a  question?  What  do  you  consider  the  most  essential  or 
most  important  part  of  the  bill? 

Mr.  Town  e  r.  I  can  not  quite  get  your  proposition . 

Mr.  Denison.  The  most  important  and  valuable  fundamental  part  of  the  bill. 
Here  is  what  I  mean,  as  between  these  two  propositions,  which  do  you  consider  the 
most  fundamentally  important:  The  granting  of  the  aid  by  the  Federal  Government 
in  the  form  of  an  apjsropriation  to  the  various  States  for  this  work,  or  the  administration 
of  it  by  the  Children's  Bureau? 

Mr.  Towner.  I  think  those  propositions  are  equally  important. 

Ml-.  Denison.  Well,  I  know,  but  then  I  am  asking  you  which  you  think  is  the  most 
valuable.  •' 

Mr.  Towner.  I  think  they  are  both  very  material.  Of  course  the  very  object  and 
purpose  of  the  bill  is  to  stimulate  into  activity  the  States.  This  amount  that  is  granted 
it  is  admitted  will  not  meet  the  requirements,  but  it  will  assist  the  States,  it  will 
stimulate  them  until  they  take  care  of  the  situation  themselves.  And  the^  placing  of 
it  in  the  Children's  Bureau  is  vastly  important,  l^ecause  after  all  the  chief  success  of 
the  bill  will  depend  on  the  measure  in  which  local  support  can  be  brought  to  it.  You 
know  what  local  support  can  be  brought  to  it  if  the  women  get  back  of  it.  They  can 
make  it  successful  anjTvhere. 

Mr.  Denisox.  Oh,  yes;  I  tliink  so.  I  think  they  can  make  anything  successful  if 
they  get  back  of  it  right. 

Mr.  Towner.  They  will  not  feel  like  it  if  you  turn  them  down,  however,  in  this 
bill. 

Mr.  Denison.  How  is  that? 

Mr.  Towner.  They  will  not  feel  like  it  if  you  take  it  away  fi'om  the  women's  ad- 
ministration. 

Mr.  Denison.  Well,  now,  let  me  ask  you  about  that.  Do  you  think  that  if  we  have 
a  different  judgment,  if  the  committee  should  have — and  I  do  not  know  how  they  feel 
about  it — a  different  judgment  as  to  who  should  administer  this  liill,  that  that  would 
amount  to  turning  the  women  of  the  country  down? 

Mr.  Towner.  I  tliink  that  is  what  they  would  think,  Mr.  Denison.     Xow  let  me 
say  this  to  you.     I  do  not  think  you  would  think  so  or  any  other  man  that  would  ^ote 
for  it  on  this  committee.     You  would  do  it  because  you  thought  that  it  was  best  for 
.  the  administration  of  the  law  when  it  became  a  law. 

Ml-.  Denison.  Well,  I  have  heard  tliis  view  expressed,  if  you  will  excuse  me,  and 
it  has  been  expressed  to  me  in  communications  received  through  the  mail,  that  rather 


262  PUBLIC   PKOTECTION    OF   MATEEOSriTY   AND   INFANCY. 

than  have  the  administration  of  this  bill  taken  from  the  Children's  Bureau,  they  would 
■  rather  have  no  legislation  at  all  on  the  subject.     Do  you  feel  that  way  about  it? 

Mr.  ToAVNER.  No,  indeed.  I  should  be  very  sorry  if  that  was  done,  and  I  think 
that  it  would  very  strongly  impede  the  progress  and  approval  of  the  bill. 

Mr.  Denison.  Yes.  Now  let  me  ask  you  this  question,  and  see  if  I  am  right:  Under 
the  law,  the  fundamental  law  as  it  now  exists,  the  activities  of  the  Children's  Biueau 
are  limited  to  investigations  and  reports,  is  that  true? 

Mr.  Towner.  Yes;  they  are  under  the  original  law,  but  certainly  tliis  bill  extends 
that. 

Mr.  Denison.  I  am  talking  about  the  present  law;  the  law  as  it  is  now. 

Mr.  Towner.  Yes. 

Mr.  Denison.  The  whole  work  that  has  been  assigned  to  the  Children's  Bureau  by 
law,  by  Congress,  has  been  investigations,  seeking  out  information,  and  reporting  that 
information  to  the  authorities. 

Mr.  Towner.  Yes;  I  grant  that. 

Mr.  Denison.  Now  this  bill  is  adding  to  the  present  existing  powers  of  the 
Children's  Bureau  an  entirely  new  field,  is  it  not?  ' 

Mr.  Towner.  Yes;  that  is  so  far  as  this  work  is  concerned. 

Mr.  Denison.  Yes.  Well,  this  goes  beyond  a  mere  matter  of  investigating  and 
collecting  information  and  reporting  the  same  back. 

Mr.  Towner.  Yes,  it  certainly  does. 

Mr.  Denison.  This  goes  beyond  that,  and  enters  into  the  f.eld  of  actual  adminis- 
tering or  giving  aid.  Now  we  have  gotten  evidence  here  from  the  communication 
you  tiled,  that  if  this  bill  is  passed  in  its  present  form  there  will  be  complete  coopera- 
tion between  the  Public  Health  Service  and  the  Children's  Bureau.  But  if  the 
Congress  or  the  committee  should  place  the  administration  of  this  new  work  that  we 
are  now  about  to  begin  upon  in  the  hands  of  the  Public  Health  Service,  do  you  think 
that  there  would  ])e  that  same  spirit  of  cooperation  between  the  Public  Health  Service 
and  the  Children's  Bureau  as  has  been  indicated  by  the  letter?  A 

Mr.  Towner.  Well,  but  the  cooperation  and  everything  is  based  upon  placing  h{ 
in  the  Children's  Bureau.     That  is  expressly  what  the  statement  is  based  on. 

Mr.  Denison.  I  know,  but  I  am  stating  now  the  other  proposition:  Suppose  it    "^ 
were  placed  in  the  Public  Health  Service,  this  new  work,  this  work  of  extending  and 
gi^dng  the  aid,  do  you  think  that  the  Children's  Bureau  then  could  or  would  go  ahead 
and  cooperate  with  the  Public  Health  Service? 

Mr.  Towner.  They  would  not  have  any  authority  for  doing  it. 

Mr.  Denison.  Well,  they  would  have  as  much  authority  as  the  Public  Health 
Service  would  have  to  cooperate  with  them  under  the  provisions  of  the  bill,  would 
they  not? 

Mr.  Towner.  No,  because  whenever  you  give  to  either  one  of  them  these  addi- 
tional duties,  3'-ou  confer  upon  the  one  and  not  upon  the  other  the  authority.  Here 
is  the  situation.  The  Children's  Bureau  here  is  acting  not  as  a  Public  Health  Service 
activity,  as  the  Public  Health  Service  is  doing  when  the  Public  Health  Service 
says  that  they  will  assist  and  cooperate  with  them  in  the  work  that  is  contemplated, 
particularly  under  the  pro^dsions  of  this  bill. 

Now  in  connection  with  the  extension  of  the  powers  of  the  Government,  I  intended 
to  speak  aljout  the  constitutional  propositions,  and  I  have  noted  here  some  of  the 
extensions  of  the  powers  of  the  Government  under  what  is  called  the  general  sYv^elfare 
clause,  in  order  to  show  them  to  those  that  have  consitutional  scruples,  and  I  should     ^ 
be  very  glad  indeed  to  discuss  it.     I  will  ask  to  have  this  statement  inserted  in  the     i 
record. 

The  Chairman.  Very  well. 

(The  statement  presented  by  Mr.  Towner  on  "general  welfare  in  legislation''  is     | 
here  printed  in  full,  as  follows:)  ' 

j 

GENERAL    WELFARE    IN   LEGISLATION.  1 

"The  Congress  shall  have  power  to  lay  and  collect  taxes,  duties,  imposts,  and 
excises,  to  pay  the  debts,  and  provide  for  the  common  defense  and  general  welfare      : 
of  the  United  States."     (Art.  1,  sec.  8,  Constitution.) 

Federal  Farm  Loan  Board:  d 

Takes  money  from  the  Federal  Treasury  to  loan  mon^y  to  the  farmers. 
War  Pvisk  Insurance  Bureau: 

To  insure  American  vessels  and  their  cargoes. 

The  lives  of  masters  and  crews  of  American  vessels. 

To  issue  term  policies  of  insurance  to  soldiers  and  sailors. 


PIUBLIC   PROTECTION   OF   MATERNITY  AND  INFANCY.  263 

Public  Health  Service: 

Division  of  Scientific  Research. 

Division  of  Sanitary  Reports  and  statistics. 

Division  of  Venereal  Diseases. 

( 'ooperate  with  State  lioard  or  departments  of  health  for  the  prevention  and  control 
of  such  diseases  within  the  States. 

Forty-six  States  receive  funds  from  Federal  Treasury. 

Secretary  Public  Health  I'klucational  Service. 

Press  bulletins,  health  posters,  lectures,  movintr  pictures,  etc. 
liureau  of  Ed\ication: 

Collects  statistics,  advises  State,  county,  and  local  school  ofTicers. 

Issues  l)ulletins. 

Schools  and  reindeer  industry  of  Alaska. 

Administers  funds  of  colleges  of  agriculture  and  mechanic  arts. 
Director.  Geological  Survey: 

Geologic  structure,  mineral  resources,  etc. 

Collecting  statistics  of  mineral  production. 
Reclamation  Service: 

Irrigation  of  arid  lands. 
Bureau  of  Mines: 

Methods  of  mining — ^Safety  of  miners. 

Treatment  of  ores  and  minerals. 

Use  of  explosives,  prevention  of  accidents. 

Production  petroleum  and  natural  gas. 

Tests  coal,  ores,  and  other  minerals. 
National  Park  Service: 

Charge  of  National  parks,  monuments,  Hot  Springs  Reservation,  Alaskan  Engi 
neering  Commission. 

Building  and  operating  railroads  in  Alaska. 

Also  operating  telegi'aph  and  telephones. 
Agriculture  Dei)artment: 

Farm  management  and  economics. 

Weather  Bureau. 

Animal  Industry. 

Plant  Industry. 

Forest  Service. 

Bureau  of  Chemistry. 

Soils,  entomology,  biology. 

Crop  estimates. 

States  Relations  service — 

Agricultural  colleges  and  experiment  stations. 
Cooperative  extension  work,  agiiculture,  and  home  economics. 
Demonstration  work,  agricultural  schools,  farmers'  institutes. 
Public  Roads: 

Federal  aid  road  act. 

Road  management  and  road  building. 

Sends  engineers  to  assist  in  building  loads. 

Builds  experiment  roads. 

Tests  road  material,  road  machines,  etc. 
Bureau  of  ^larkets: 

Marketing  and  distribution  faiin  products. 

Grading,  handling,  and  packing. 

Accounting  and  business  practices. 

OrgardzJBg  rural  community  associations. 

Reports  supply,  movement,  piices,  fruits,  etc. 

Advises  as  to  exporting,  issues  bulletine. 

Buys  and  sells  nitrates  to  fanners,  etc. 
Commerce  Department: 

Developing  industries,  United  States  markets  at  home  and  abroad. 

Appoints  trade  agents,  gathers  statistics. 
Bureau  of  Standards: 

Establishes  standards,  weights,  and  measur?s. 

Physical  constants  and  properties  ot  materials. 

Advises  States,  cities,  colleges,  firms,  corporations,  and  individuals. 


264  PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY. 

Bureau  of  Fisheries: 

Propagation  fish,  lobsters,  oysters,  etc. 

Locating  fishing  grounds. 

Methods  of  fishing. 

Has  charge  of  salmon  fisheries  of  Alaska,  fur-seal  herd  of  Pribilof  Islands,  and 
protection  sponges  off  coast  of  Florida. 
Children's  Bureau: 

Welfare  children  and  child  life. 

Especially  investigate  the  questions  of  infant  mortality,  birth 'rate,  diseases  of 
children,  etc. 
Women's  Bureau: 

Welfare  of  wage-earning  women . 
United  States  Emjjloyment  Service: 

Improving  working  conditions . 

Advance  opportunities  for  profitable  employment. 
Federal  Board  for  Vocational  Education: 

Promotes  vocational  education  by  appropriations  to  the  limit  of  $7,367,000  in  1925. 

In  agriculture,  trades  and  industries,  preparation  of  teachers. 

Cooperation  of  States  conditioned  upon  like  State  appropriations,  upon  plans 
approved  by  board. 
Federal  vocational  rehabilitation  act: 

Provides  vocational  education  for  disabled  soldiers. 
Industrial  rehabilitation  act: 

Cooperates  with  States  to  aid  persons  disabled  in  the  industries  under  plans 
approved  by  Federal  board. ' 

House  of  Representatives,  United  States, 

Washington,  D.  C,  July  13,  1921. 
Hon.  Samuel  E.  Winslow, 

Chairman  Committee  on  Interstate  and  Foreign  Com.merce, 

House  of  Representatives. 
My  Dear  Mr.  Winslow:  In  connection  with  the  hearings  which  are  being  con- 
ducted by  your  committee  upon  H.  R.  2.366  by  Congressman  Towner,  extending  Fed- 
eral aid  for  "the  protection  of  maternity  and  infancy,  I  beg  to  submit  for  consideration 
certain  correspondence  which  I  have  received  from  the  authorities  of  Porto  Rico  in 
reference  to  this  measure. 

I  wish  to  bring  forcibly  to  the  attention  of  the  committee  the  justice  of  extending 
the  provision  of  this  legislation  to  the  people  of  Porto  Rico.  As  is  stated  by  Health 
Commissioner  Dr.  Ruiz  Soler,  there  is  a  lamentably  large  number  of  Porto  Rican 
women  whose  condition  would  be  alleviated  by  extending  the  provisions  of  this 
legislation  to  that  island. 

I  am  therefore  writing  to  ask  that  the  resolution  be  so  amended  as  to  embrace  Porto 
Rico,  providing  that  the  legislature  of  the  island  shall  comply  with  the  terms  that  are 
exacted  of  the  legislatures  of  the  several  States  in  order  to  secure  the  benefits  of  this 
Federal  assistance.  Surely  there  can  be  no  objection  to  such  action,  and  on  behalf 
of  the  psople  of  Porto  Rico  I  am  writing  to  ask  that  H.  R.  2366  be  so  amended  before 
being  reported  by  the  committee. 
Very  truly  yours, 

Felix  Cordova  Davila. 


San  Juan,  P.  R.,  June  21,  1920. 
My  Dear  Judge  Cordova  Davila:  I  am  transmitting  to  you  herewith  a  trans- 
lated copy  of  a  letter  addressed  to  me  by  the  commissioner  of  health  of  Porto  Rico 
calling  attention  to  a  certain  bill  introduced  in  Congress  providing  for  financial  aid 
to  the  States  in  their  efforts  to  protect  maternity  and  infancy  and  reque.sting  your 
good  offices  so  that  Porto  Rico  may  share  the  benefits  of  said  legislation. 

I  need  not  discuss  the  gravity  of  this  social  problem  in  Porto  Rico  nor  emphasize 
the  importance  and  necessity  of  its  solution,  for  you  are  as  fully  conversant  with  it 
as  we  are,  and  I  know  you  "will  cherish  the  opportunity  to  do  everything  in  your 
power  to  secure  the  extension  of  the  benefits  of  this  legislation  to  Porto  Rico. 
Very  sincerely,  yours, 

JosB  E.  Benedicto, 

Acting  Governor. 
Hon.  Felix  Cordova  Davila, 

Resident  Commissioner  for  Porto  Rico,  House  of  Representatives . 


.PUBLIC   PROTECTIOX   OF    MATEEXITY   AND   INFANCY.  265 

Departmuxt  of  IIiCAi/nr. 

Office  of  Tin*:  Commissionkr, 
San  Juan,  P.  R.,  June  11,  1920. 

Sir:  On  the  5th  of  December,  1919,  resolution  No.  10925  was  introduced  in  the 
House  of  Representatives  of  the  United  States  Congress  by  the  Hon.  Horace  M. 
Towner  of  Iowa.  On  October  20.  1919,  the  same  I)ill  under  No.  3259  was  introduced 
in  the  Senate  by  Senator  Morris  Shejipard  of  Texas. 

As  set  forth  in  the  mentioned  resolution,  it  is  provided  that  a  sum  of  money  from 
the  Federal  Tn-asury  to  the  amount  of  .$2,000,000,  for  the  first  year,  and  thereafter 
increasin,!];  installments  until  the  sum  of  $4,000,000  y''ai-ly  shall  be  spent  in  the  public 
protection  of  maternity  and  infancy,  in  the  various  States  of  the  Union,  according 
to  their  jjopulation.  provided  that  each  State  shall  agree  to  spend  an  equal  amount 
of  money  for  the  same  purpose,  within  the  terms  of  a  plan  to  be  agreed  upon  between 
them  and  the  Federal  (Jovernment. 

We  have  a  coi)y  of  the  House  resolution  and  know  that  the  Puldic  Health  and  the 
National  Quarantine  Committee  of  the  Senate,  on  the  i2th  ultimo,  held  a  public 
hearing  in  which  the  matter  was  discussed,  and  that  afterwards  the  resolution  was 
favorably  reported  on  by  the  comraittfe,  and  the  bill  now  is  pending  action  by  the 
next  session  of  Congress. 

The  fathers  of  the  bill,  so  it  appears,  aimed  to  help  and  stimulate  the  States  in 
their  efforts  to  protect  maternity  and  infancy,  which  efforts  in  many  cases  are  ham- 
pered by  the  lack  of  sufficient  funds. 

This  department,  fully  cognizant  of  the  lamentable  circumstances  attending  the 

Srocess  of  the  august  function  of  maternity  in  an  immensely  large  number  of  Porto 
»ican  women,  and  realizing  the  destitution  into  which  an  equal  number  of  children 
is  thrown  during  the  first  years  of  their  pilgrimage  through  life,  thinks  that  no  com- 
munity of  those  subject  to  the  jurisdiction  of  the  United  States  Congress  is,  -with  more 
powerful  reasons,  more  entitled  to  and  deser\'ing  of  the  help  of  the  Federal  Treasury 
than  the  people  of  Porto  Rico,  where,  unfortunately,  year  after  year,  and  in  spite  of 
the  efforts  of  the  health  authorities,  we  have  a  high  average  of  infantile  mortality 
and  of  deaths  resulting  from  childbirth. 

It  does  not  appear  that  the  pro\'isions  of  the  said  resolution  will  apply  to  Porto 
Rico.  We  believe,  however,  that  if  it  were  made  extensive  to  this  island  we  could 
stir  and  shape  public  opinion  so  that  we  may  secure  favorable  action  by  our  legisla- 
ture to  the  end  that  the  law  may  be  made  operative  in  Porto  Rico. 

Therefore,  we  rec(uest  you  to  address  yourself  to  the  honorable  Resident  Commis- 
sioner for  Porto  Rico  in  Washington,  so  that  he,  in  turn,  availing  himself  of  the  op- 
portunities as  they  should  present  themselves,  shall  procure  the  amendment  of  the 
law  so  that  the  same  is  made  applicable  to  Porto  Rico. 

We  are  sure  that  both  you  and  the  honorable  Resident  Commissioner  will  give  this 
proposition  as  warm  and  cordial  a  reception  as  you  always  accord  to  all  altruistic  and 
patriotic  undertakings. 
Respectfully, 

A.    Ruiz    SOLER, 

Public  Health  Commissioner. 
The  Governor  of  Porto  Rico, 

San  Juan,  P.  R, 

Mr.  Barkley.  Speaking  to  the  fact  that  the  Children's  Biureau.  as  originally  created 
only  had  the  power  to  investigate  and  report,  I  suppose  the  analogy  is  that  therefore 
it  ought  never  to  be  given  any  additional  powers? 

Mr.  Denison.  I  did  not  make  any  suggestion  of  that  kind. 

Mr.  Barkley.  Then  I  will  withdraw  that  suggestion.  But  is  it  not  true,  that  many 
bureaus  have  been  created  in  the  history  of  ithe  Government  since  the  beginning 
only  to  investigate  and  find  out  conditions,  and  after  they  have  made  those  investi- 
gations and  ascertained  the  conditions.  Congress  conferred  upon  them  the  power  in 
some  measure  to  relieve  the  conditions  which  the  reports  and  investisations  revealed? 

■  Mr.  Towner.  That  is  exactly  what  occurred  here.  In  maldng  these  investigations 
the  Children's  Bureau  has  ascertained  what  they  think  needs  a  remedy.  They  have 
ascertained  conditions  which  they  think  are  "deplorable.  Thev  haA-e  found  out 
methods  which  tliey  think  we  can  inaugurate  that  will  materially,  wonderfully  in 
fact,  alle\-iate  conditions  and  benefit  the  people  who  will  be  affected,  and  they' ask 
that  that  power  be  given  to  them  in  addition  to  the  powers  that  they  now  have. '  I  do 
not  see  anything  strange  in  that  or  unreasonable. 

Again  I  "thank  the  committee  for  their  attendance  and  attention. 

(ilr.  Winslow  then  resumed  the  chair.) 

The  Chairman.  Does  anybody  A\ish  to  ask  any  questions?  If  not,  we  will  call  this 
hearing  at  an  end. 


266  PUBIJC   PEOTECTIOK    OF   MATEE:XITY  XNT)   I'NYA'NGY. 

VOLUNTARY    COMMITTEE. 

.  Tlie  Slieppard-Towner  emergency  committee  was  organized  in  New  York  City- 
some  week?  ago  to  educate  the  public  to  the  need  for  the  Sheppard-Tovrner  maternity 
bill,  and  to  conduct  actively  a  campaian  in  favor  of  the  proA-isions  of  the  bill.  It  is 
made  up  of  men  and  women  in  all  walks  of  life,  who  have  the  interest  of  the  future 
welfare  of  the  country  at  heart.  Represented  on  it  are  some  of  the  leading  members 
of  the  medical  profession.  A  list  of  membership  follows:  C.  H.  Hathaway,  chairman, 
119  West  Fortieth  Street,  New  York;  A.  W.  Rosenthal,  secretary;  Dr.  Eugene  Lyman 
Fisk,  director  of  the  Life  Extension  Institute;  Rev.  Percy  Stickney  Grant;  Senator 
Nathan  Straus,  jr.;  Sophie  Irene  Loe]?;  Mrs.  Florence  Kelley,  secretary  National 
Consumers'  League:  Dr.  Royal  S.  Copeland,  health  commissioner  of  New  York;  Dr. 
S.  Josephine  Baker;  Dr.  Richard  A.  Bolt,  general  director  American  Child  Hygiene 
Association;  Dr.  Haven  Emerson;  Rabbi  Stephen  S.  Wise;  Mrs.  Enrico  Caruso;  Mrs. 
Julius  Rosenwald:  Professor  Irving  Fisher,  department  of  poHtical  economy,  Yale 
L'niversity ;  ^Irs.  Henry  ]\Ioskowitz;  ]\Irs.  Jlirian  Finn  Scott;  Ernest  Poole;  Will  Irwin; 
Dr.  C.  A.  Hamann.  dean  school  of  medicine.  Western  Reserve  LTniversity;  Dr.  J.  C. 
Blake,  dean  Hahnemann  Medical  Colle2;e  and  Hospital,  of  Chicaso;  Dr.  W.  A.  Pearson, 
dean  of  The  Hahnemann  Medical  College  and  Hospital,  of  Philadelphia;  Dr.  John 
Haynes  Holmes;  and  John  A.  Kingsbury. 

SOME    INDORSEMENTS   FROM   PHYSICIANS. 

Dr.  C.  A.  Hamann:  I  am  fully  in  sympathy  with  the  provisions  of  the  Sheppard- 
Towner  maternity  bill,  which  provides  for  the  public  protection  of  maternity  and 
infancy,  and  believe  the  measures  advocated  therein  to  be  highly  commendable. 

Dr.  E.  P.  Lyon,  dean  of  medical  school  University  of  Minnesota:  I  am  very  glad 
to  add  what  influence  I  may  possess  to  the  large  body  of  public  opinion  which  is  in 
favor  of  the  Sheppard-Towner  maternity  bill. 

I  have  consulted  with  the  professor  and  associate  professor  of  obstetrics  in  the 
I^niversity  of  ^Minnesota  and  find  that  thev  are  both  strongly  in  favor  of  this  action 
by  our  Congress.  We  surely  trust  that  the  bill  will  pass  and  put  our  country  on  record 
as  doing  at  least  something  to  prevent  the  large  number  of  deaths  in  childbirth  and 
the  enormous  number  of  infant  mortalities  which  occur  in  this  country. 

Dr.  J.  C.  Blake:  I  take  pleasure  in  indorsing  the  Sheppard-Towner  maternity  bill 
and  would  be  glad  to  render  any  further  assistance  that  I  can. 

Dr.  S.  J.  Crumbine,  secretary  State  board  of  health,  Topeka,  Kans.:  I  shall  be  very' 
glad  to  have  you  use  my  name  as  an  indorsement  of  the  Sheppard-Towner  maternity 
bill  and  will  give  statements  to  the  press  when  called  upon. 

Dr.  Royal  S.  Copeland:  Measures  similar  to  those. advocated  in  Sheppard-Towner 
bill  have  resulted  in  reducing  infant  death  rate  in  New  York  City  from  144  to  85  per 
1,000  births.    ]\Iedical  profession  here  cooperate  in  our  e  ~orts.    No  opposition  encount-^ 
ered.    Mothers  ask  us  for  information  and  help.    I  heartily  indorse  bill. 

Dr.  Haven  Emerson:  Reduction  of  50  per  cent  preventable  deaths  of  babies,  10 
per  cent  maternal  deaths,  and  much  invalidism  from  childbirth,  assured  from  modest 
cost  involved  in  Sheppard-Towner  bill.  It  costs  less  to  save  a  life  than  to  bury  a 
babe.  Support  of  medical  leaders  certain  for  such  measures  to  reduce  sickness  and 
deaths. 

INDORSEMENTS    FROM    PROMINENT   MEN   AND    WOMEN. 

Ernest  Poole,  author:  The  Sheppard-Towner  maternity  bill  seems  to  me  to  be  a 
measure  deser^dng  the  strong  indorsement  of  every  American  citizen  who  wishes  to 
line  up  in  the  fight  for  the  conservation  of  our  vital  resources — the  prevention  of 
needless  pain  and  death,  the  intelligent  protection  of  human  life  and  happiness. 

Miriam  Finn  Scott,  educator:  The  passing  of  this  bill  will  lay  the  foundation  stone 
of  a  more  enlightened  parenthood  and  a  more  wholesome  race  and  it  will  do  more  to 
fortify  this  country  than  the  most  powerful  and  costly  battleships.  I  have  faith 
enough  in  mankind  to  believe  that  no  opposition  can  prevent  the  Sheppard-Towner 
maternity  bill  from  becoming  a  law. 

Do  the  objectors  to  this  bill  realize  that  a  great  percentage  of  imbeciles,  epileptics, 
insane,  and  criminals  who  fill  our  public  institutions,  which  drain  our  Nation  spirit- 
ually and  economically,  can  be  traced  back  to  a  neglected  infancy  and  in  turn  to  a 
neglected  prenatal  condition? 

Nathan  Straus,  jr.,  State  senator  fi'om  New  York:  I  am  heartily  in  favor  of  the 
Sheppard-Towner  bill.  Its  immediate  passage  is  necessary  for  the  welfare  of  the 
mothers  and  children  of  our  country. 

Prof.  Irving  Fisher,  of  Yale  University:  I  take  gi'eat  pleasure  in  indorsing  th^ 
Sheppard-Towner  maternity  bill.    I  know  of  few  bills  which  have  been  before  Con- 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  267 

p:ress  which  I  believe  so  worthy  of  support.  If  passed  it  will  not  only  save  many 
lives  but  save  many  times  the  money  which  its  administration  will  cost.  Further- 
more, it  will  help  enormously  the  Americanization  movement  in  which  every  public- 
spirited  American,  whether  radical  or  conservative,  most  earnestly  believes. 

The  loni,'est-lived  country  is  Sweden,  and  when  I  attended  the  International 
Hygiene  Exhilution  in  1911,  the  chief  reason  assigned  was  the  high  maternity  .stand- 
ard. The  investigations  which  have  Ijeen  made  through  the  Children's  Bureau 
show  that  most  of  the  United  States  is  at  j^resent  inade()uately  equipped  for  prenatal 
or  maternal  care.  Over  25,000  women  die  yearly  in  this  country  from  childbirth 
or  from  causes  connectfid  therewith.  Tho'death  rate  of  infants  is  higher  than  in  many 
progix^ssive  countries.  Where  the  principles  of  the  Sheppard-Towner  bill  have  l;een 
appUe<l  the  death  rate  has  been  cut  in  half. 

Tliei-e  is  danger  of  short-sightedness  in  the  present  cry  of  "economy."  To  reject 
the  Sheppard-Towner  lull  because,  in  the,  first  instance,  it  costs  money,  is  being  "  penny 
wise  and  pound  foolish."  Just  because  we  are  learning  the  need  of  wise  economies 
we  need  this  far-sighted  national  economy.  The  Sheppard-Towner  bill  would  not 
only  save  money  for  families  by  teaching  women  the  elements  of  maternity  and  save 
funeral  ex]ienses  and  damage  to  the  bread-winning  power  of  the  future  generation, 
which  savings  run  into  millions  of  dollars,  liut  it  would  sa^'e  the  Public  Treasury 
directly  and  immediately  considerable  of  the  cost  of  hospitals  and  almshouses  now 
incurred  because  of  the  fatal  ignorance  of  our  un-Americanized  industrial  women. 

YOUNG    women's    CHRISTIAN    ASSOCIATION. 

The  national  board  and  the  executive  committee  of  the  Young  Women's  Christian 
Association  of  the  United  States  of  America,  which  have  had  experience  of  work 
among  girls  and  women  for  a  period  of  more  than  50  years,  officially  indorsed  the 
Sheppard-Towner  maternity  and  infancy  bill  March  10,  1920. 

Mrs.  Robert  E.  Speer, 

President- National  Board. 


CONGRESS    OF   MOTHERS. 

We  favor  the  maternity  bill  because  we  believe  the  health  of  the  American  people 
demands  quick  rebuilding  to  offset  the  tide  of  degeneracy  already  setting  in.  The 
fact  that  the  State  and  Canadian  boards  of  health  meeting  at  the  congress  of  the  Amer- 
ican Medical  Society  indorsed  the  bill  despite  the  fact  that  they  objected  to  its  plans 
of  administration  shows  its  value. 

They  said,  "We  have  to  indorse  it  because  it  will  save  so  many  lives.  "  As  for  the 
objection,  namely,  that  the  Public  Health  Service  should  be  the  administrator 
rather  than  the  Children's  Bureau,  we  say  this  is  a  matter  to  be  worked  out  in  the 
coming  reorganization  of  departments,  when  all  health  activities  will  be  grouped 
under  one  head.     Don't  endanger  or  lose  100,000  babies  annually  for  a  technicality. 

As  for  the  other  objection — Federal  aid — the  Congress  of  Mothers  believes  in  Fed- 
eral aid  because  it  sees  no  other  way  of  bringing  the  backward  spots  forward.  It 
is  the  only  way  of  making  us  100  per  cent  efficient.  We  gave  it  to  hogs  because  we 
realize  that  a  bad  hog  here  and  there  does  not  make  an  efficient  national  product. 
Why  not  realize  that  a  good  baby  here  and  there  is  not  an  efficient  national  product? 
Whv  not  strike  for  the  ideal — a  good  baby  everywhere?  This  is  not  socialism;  this 
is  the  old  doctrine  of  "United  we  stand,  divided  we  fall."  The  rich  States  give 
most,  but  the  benefits  of  an  efficient  drop  of  human  beings  flow  back  to  every  State. 

Elizabeth  Tilton,  Legislative  Chairman. 


CONFERENCE    OF    STATE    AND   PROVINCIAL    HEALTH   AUTHORITIES. 

At  request  of  Dr.  McCormack,  of  Kentucky,  am  sending  excerpts  from  records  of 
December  G,  1920,  meeting  of  executive  committee  of  Conference  of  State  and  Pro- 
vincial Health  Authorities  held  in  Washington.  As  a  result  of  conferences  with 
Surgeon  General  .(dimming,  Julia  Lathrop,  and  Dr.  Anna  Rude,  it  was  agreed  that 
certain  amendments  to  the  Sheppard-Towner  bill  would  be  offered,  and  that  in  view 
of  these  the  executive  committee  of  the  Conference  of  State  and  Provincial  Health 
Authorities  would  actively  support  the  bill.  Recommendations  concurred  in  Avere 
as  follows,  that  administrative  responsibility  should  rest  upon  the  chief  of  the  Chil- 
dren's Bureau  instead  of  being  lodged  in  an  interdepartmental  body  such  as  contem- 


268  PUBLIC   PROTECTION    OF   MATEPtNITY   AND   INFANCY. 

plated  in  the  early  draft  of  the  bill.  It  was  agreed,  however,  that  an  advisory  body 
consisting  of  the  Surgeon  General  of  the  United  States  Public  Health  Service  and  the 
Secretary  of  Agricultural  and  United  States  Commissioner  of  Education  should  be 
appointed.  That  the  bill  shall  specify  that  in  any  State  having  a  child-welfare  or 
child-hygiene  division  in  its  State  health  agency  said  State  health  agency  shall  ad- 
minister the  provisions  of  this  act.  A  committee  consisting  of  Dr.  McCormack  and 
Dr.  Kelley  was  appointed  to  confer  with  Miss  Lathrop.  This  committee  later  reported 
that  Miss  lathrop  concurred  in  the  proposed  amendments  to  the  Sheppard- Towner 
bill  and,  furthermore,  that  she  expressed  entire  sympathy  with  the  movement  for  a 
consolidation  of  all  Federal  health  agencies-and  would  lend  her  support  to  the  ap- 
proved plan.  At  a  meeting  held  at  Boston  June  4,  1921,  a  resolution  was  unanimously 
adopted  by  the  executive  committee  of  the  Conference  of  State  and  Provincial  Health 
Authorities  of  North  America  instructing  the  secretary  to  send  a  telegram  to  the 
Vice  President  of  the  United  States  and  to  the  Speaker  of  the  House  of  Representatives 
urging  the  passage  of  the  Sheppard-Towner  bill  as  amended. 

:    R.  M.  Olin,  M.  D., 
Secretary  Conference  of  State  and  Pi'ovincial  Health  Authorities. 


GENERAL    FEDERATION    OF    WOMEN's    CLUBS. 

The  General  Federation  of  Women's  Clubs,  an  organization  of  bipartisan  women, 
2,000,000  strong,  has  indorsed  unanimously  the  Sheppard-Towner  bill  for  the  prote<'- 
tion  and  care  of  maternity  and  infancy. 

We  urge  your  cordial  support  of  this  measure,  and  that  you  do  everything  you  can 
to  secure  its  early  passage  at  this  session  of  Congress. 
Yovirs,  very  sincerely, 

Mrs.  Edward  Franklin  White, 
Chairman  Legislative  Department,  General  Federation  of  Wom(m's  Clubs. 


RESOLUTION   NO.   102. 

By  Delegate  James  J.  Forrester,  Brotherhood  of  Railway  and  Steamship  Clerks, 
Freight  Handlers,  Express  and  Station  Employees: 

"Whereas  a  bill  commonly  known  as  the  Sheppard-Towner  maternity  bill  has  been 

introduced  in  both  Houses  and  is  now  before  the  Congress  of  the  United  States 

for  consideration  and  action;  and 
"Whereas  this  bill,  if  enacted  into  law,  will  promote  scientific  care  (medical  and 

nursing)  to  mother  and  child  prior  to,  during,  and  following  childbirth,  at  the 

expense  of  the  Federal  and  State  Governments;  and 
"Whereas  such  scientific  care  will  materially  reduce  the  death  rate  of  mothers  during 

the  maternity  period  and  of  children  'stillborn'  and  of  those  who  die  within  a 

short  period  after  birth,  the  number  of  which  is  now  enormous  and  appalling;  and 
"Whereas  tMs  humanitarian  proposed  law  is  being  bitterly  fought  by  reactionaries, 

both  in  and  out  of  Congress,  and  by  the  forces  antagonistic  to  organized  labor, 

wMch  is  endangering  its  enactment:  Now,  therefore  be  it 
"Resolved,  By  the  delegates  to  this,  the  Forty-first  Annual  Convention  of  the  Ameri- 
can Federation  of  Labor,  assembled  at  Denver,  Colo.,  that  we  most  earnestly  indorse 
the  said  Sheppard-Towner  maternity  bill  and  urge  upon  Congress  its  enactment  into 
law;  and  further  be  it 

"Resolved,  That  the  executive  council  of  the  American  Federation  of  Labor  be,  and 
is  hereby,  instructed  to  make  every  effort  and  use  all  available  means  to  carry  out  the 
purposes  of  this  resolution,  to  the  end  that  tliis  meritorious  and  humanitarian  proposed 
law  be  passed  by  the  Congress,  signed  by  the  President,  and  made  operative  within 
the  several  States." 

The  committee  concurs  in  the  resolution  and  recommends  its  adoption. 
The  recommendation  of  the  committee  was  unanimously  adopted . 


The  following  are  additional  indorsements  of  the  bill : 

State  board  of  health  and  county  and  city  health  oflicers,  Kentucky. 

American  Association  of  University  Women. 

American  Home  Economics  Association. 

Girls'  Friendly  Society  of  America. 

National  Federation  of  Business  and  Professional  Women. 

Maryland  State  and  District  of  Columbia  Federation  of  Labor. 


PUBLIC   PROTECTION    OF    MATERNITY   AND   INFANCY.  269 

Maternity  Hospital  Association. 

Home  Economics  Club,  New  Mexico. 

President  Mount  Holyoke  College. 

Director  training  school,  Smith  College. 

Head  department  economics  and  sociology,  Wellesley  College. 

Albert  Bushnell  Hart,  director  Moosoliead  School. 

Children  of  the  Henry  Street  (New  York)  Settlement. 

Texas  Congress  of  Mother  and  Parent-Teacher  Associations,  Pennsylvania. 

Executive  l)oard  Worcester,  Mass.,  Clinic  League. 

Worcester,  Mass.,  League  of  Women  Voters. 

Worcester,  Mass.,  Women's  Trade  League. 

Worcester,  Mass.,  Women's  Club. 

Worcester  Council  .Temsh  Women. 

TJoston  Tjoague  of  Women  Voters. 

Secretary  Uoston  Children's  Aid  Society. 

Secretary  Boston  Societ}''  for  Care  of  Girls. 

Connecticut  Daughters  American  Revolution. 

American  Child  Hygiene  Association. 

National  Consumers'  League. 

National  Council  of  Jewish  Women. 

National  League  of  Women  Voters. 

National  Organization  of  Public  Health  Nursing. 

National  Society  Daughters  American  Revolution. 

National  Woman's  Christian  Temperance  Union. 

National  Women's  Trade  Union  League. 

Service  Star  Legion. 


The  following  are  a  few  of  the  typical  letters  received  from  physicians  and  non- 
medical citizens: 

THE   JOHNS   HOPKINS   HOSPITAL. 

[Winford  H.  Smith,  M.  D.,  director;  William  S.  Halsted,  M.  D.,  surgeon  in  chief;  William  S.  Thayer, 
M.  D.,  physician  in  chief:  J.  Whitridge  WilUams,  M.  D.,  obstetrician  in  chief:  John  Howland,  M.  D., 
pediatrician  in  chief:  Adolf  Meyer,  M.  D.,  psycliiatrist  in  chief;  William  C.  MacCaUura,  M.  D.,  path- 
ologist.] 

July  12,  1921. 
Hon.  Samuel  E.  Winslow, 

House  of  Representatives,  Washington,  D.  C. 

My  Dear  Mr.  Winslow:  I  had  expected  to  attend  the  hearing  to-day  on  the 
Sheppard-Towner  bill,  but  unfortunately  was  prevented  from  doing  so.  As  I  did 
not  have  an  opportunity  to  say  publicly  what  I  think,  I  am  taking  the  liberty  of 
writing  you. 

I  hope  that  the  bill  in  its  present  form  will  go  through,  as  I  feel  very  strongly  that 
the  matters  covered  by  it  should  be  directed  by  physicians  and  not  by  laymen. 
Consequently,  I  hope  that  if  anything  is  done  in  the  matter,  that  the  direction  will 
be  put  in  the  Public  Health  Service,  at  least  pending  the  formation  of  a  national 
department  of  health. 

In  making  this  recommendation  I  hope  you  will  understand  that  I  am  making 
no  criticism  of  Miss  Lathrop,  the  head  of  the  Children's  Bureau.  She  has  done 
extremely  well  in  her  post,  but  I  do  not  feel  that  the  Department  of  Labor  is  the 
branch  of  the  Government  which  should  have  to  deal  with  medical  matters. 

Regretting  to  trouble  you,  I  am, 
Tom's,  very  truly, 

J.  Whitridge  Williams. 


THE   JOHNS    HOPKINS    HOSPITAL. 

Winford  H.  Smith,  M.  D.,  director;  William  S.  Halsted,  M.  D.,  surgeon  in  chief:  WiUiam  S.  Thayer, 
M.  D.,  physician  in  chief:  J.  Whitridge  Williams,  M.  D.,  obstetrician  in  chief:  John  Howland,  M.  D., 
pediatricia"n  in  chief;  Adolf  Mayer,  M.  D.,  psychiatrist  in  chief;  WiUiam  G.  MacCaUum,  M.  D.,  path- 
ologist.] 

July  12,  1921. 
Hon.  Samuel  E.  Winslow, 

House  of  Representatives,  Washington,  D.  C. 
My  Dear  Mr.  Winslow:  Your  courteous  invitation  to  a])pear  before  the  Committee 
on  Interstate  and  Foreign  Commerce  of  the  House  of  Representatives  with  refer- 
ence to  the  consideration  of  the  Sheppard-Towner  bill,  H.  R.  2366,  has  been  received. 
I  am  sorry  that  illness  will  prevent  me  from  doing  so.  May  I,  however,  state  briefly 
my  objections  to  the  bill? 


270         PUBLIC  protectiojst  of  maternity  and  infancy. 

In  the  first  place,  I  am  unwilling  to  believe  that  such  emergency  exists  as  has 
been  claimed  regarding  maternal  care  in  this  country  and  I  am  quite  sure  from  con- 
siderable experience  with  statistics  that  there  is  no  basis  for  the  statement  that  the 
United  States  stands  seventeenth  in  maternal  death  rate.  Even  civilized  countries 
have  not  sufficiently  accurate  statistics  to  enable  anyone  to  make  a  definite  state- 
ment such  as  this. 

I  do  not  believe  that  the  way  to  improve  health  matters  in  States,  except  those 
that  have  a  distinctly  national  or  interstate  application,  is  by  Federal  supervision 
or  control.  Public-health  work  depends  upon  enlightened  local  interest.  It  can 
not  be  improved  by  influence  directed  from  a  distance. 

If  such  work  as  the  Sheppard-Towner  bill  provides  is  to  be  undertaken,  it  should 
be  undertaken  by  the  United  States  Public  Health  Service  and  not  by  a  subdepart- 
ment  of  the  Department  of  Laljor.  Indeed  it  appears  peculiar  to  most  physicians 
who  are  interested  in  work  for  the  benefit  of  children  that  the  care  of  children  should 
be  a  function  of  the  Department  of  Labor.  The  work  is  now  in  improper  surroundings. 
To  increase  and  expand  the  work  of  the  Children's  Bureau  where  it  now  is  is  only  to 
make  matters  wor?e. 

Finally  and  chiefly  I  ani  opposed  to  the  bill  because  I  am  opposed  to  the  granting 
of  subsidies  to  Statesby  the  Federal  Governm.ent  for  work  which  is  purely  local  in  the 
States.  It  is  to  my  mind  an  unsound  financial  policy  and  a  dangerous  step  toward 
the  centralization  in  Washington  of  matters  which  properly  belong  to  the  States 
themselves. 

Respectfully,  yours, 

John  Howland. 


Boston,  July  5,  1921. 
Hon.  Samuel  E.  Winslow, 

House  of  Representatives,  United  States  Congress. 
'    Dear  Mr.  Winslow:  I  take  the  liberty  of  writing  you  to  express  my  entire  dis- 
approval of  congressional  action  "for  the  purpose  of  cooperating  with  the  several 
States  in  promoting  the  care  of  mayernity  and  infancy."'     The  proposed  bill  is,  I 
"believe,  known  as  the  Sheppard  m.aternity  bill. 

I  could  go  to  great  length  in  giving  my  reasons  for  being  opposed  to  such  congres- 
sional legislation,  and  would  do  so,  if  I  believed  it  to  be  necessary.  But  I  will  not 
take  your  time  nor  mine  to  do  so.  I  will  say,  however,  that  I  think  I  know  something 
about  the  whole  case.  I  taught  for  over  30  years  in  the  Harvard  Medical  School,  in 
the  department  of  diseases  of  women  and  obstetrics.  I  was  for  36  years  connected 
with  the  Boston  Lying-in  Hospital,  and  I  am  still  connected  with  the  Boston  City 
Hospital,  although  I  am  gradually  retiring  from  active  professionsl  life.  As  far  back 
as  1894  I  began  writing  about  the  necessity  of  medical  care  of  pregnant  women,  and 
was  a  pioneer  in  this  matter  long  before  I  became  the  head  of  my  department.  Some 
years  ago,  when  I  was  at  the  head  of  the  Boston  Lying-in  Hospital,  I  established  a 
special  clinic  to  care  for  the  pregnant  women;  and  the  clinic  has  grown  and  developed, 
and  now  the  hospital  has  three  clinics  scattered  over  the  city  for  this  purpose.  There 
is  also  such  a  clinic  at  the  Boston  City  Hospital,  at  the  Boston  Dispensary,  and  at 
many  other  Boston  institutions.  And  pupils  of  mine  have  established  such  clinics  in 
other  cities  and  States.  Indeed,  it  is  generally  recognized  by  the  medical  profession 
all  over  the  more  highly  developed  sections  of  the  country  that  pregnant  women 
should  be  looked  aftex  with  a  view  to  preventing  disasters  in  subsequent  childbirth. 

Now  all  this  is  going  on  as  a  matter  of  general  education,  and  progress  is  making  all 
the  time.  There  are  some  things  that  are  better  left  to  the  education  of  the  people, 
guided  by  the  medical  profession,  and  the  many  altruistic  societies  devoted  to  huinan 
welfare,  than  to  undertake  to  further  such  objects  by  law,  by  congressional  activity. 
You  are  probably  aware  that  the  Massachusetts  Legislature  threw  out  a  somewhat 
similar  bill  this  last  session.  It  was  opposed  by  the  profession  generally  as  a  piece  of 
medical  communism.  And  yet  the  doctors  are  the  ones  who  are  working  to  bring 
about  the  desired  end  bA'  their  work  and  their  influence  in  the  education  of  the  people. 

I  will  not  take  more  of  3^our  time.  But  I  sincerely  hope  that  your  committee  will 
not  favor  the  proposed  bill,  and  put  into  the  <  'hildren's  Bureau,  which  knows  little  of 
medicine,  a  problem  on  which  the  medical  men  all  over  the  country  are  now  working 
for  the  general  good,  and  which  will  only  becom.e  effective  as  the  people  gradually 
become  more  educated  to  their  best  interests  in  the  matters  under  consideration. 
Yours,  very  truly, 

Charles  M.  Green,  M.  D., 
Professor  of  Obstetrics  and  Gynaecology,  Emeritus,  in  Harvard  University. 


PUBLIC   PROTECTION    OF    MATEKNITY   AND   INFANCY.  271 

Dahkhakbor,  Me.,  Juhi  10. 
Hon.  Samuel  E.  Winslow. 

Dear  Sik:  A  reaident  of  Boston,  inerelv  anmniciinf,'  hero.  1  write  to  express  my 
disapproval  of  the  Sheppard  maternity  hill,  certainly  as  now  drafted. 

In  the  (inst  plare  1  am  douhtfnl  as  to  the  principle  of  the  hill.  Is  nothinjj  to  he  left 
to  the  initiative  of  the  citizen? 

It  seems  (o  me  we  should  ,g:o  slow  in  a  Germanic  assumption  hy.  the  State  of  all  sorts 
of  control  of  the  citizen.  Secondly,  if  we  must  have  this  legislation  is  it  not  more 
sensihle  to  put  its  operation  in  the  char£^e  of  the  Department  of  Public  Health  than 
in  that  of  the  Children's  Bureau  of  the  Department  of  Labor? 

Surely  this  is  a  matter  that  can  wait  for  mature  consideration  and  a  time  when 
public  economy  is  less  urgent. 
Yours  very  truly, 

F.  C.  Shattuck,  M.  D.. 
Professor  of  Clinical  Medicine  Emeritus, 

Overseer  Harvard  College  1913-1919,  etc. 


July  9,  1921. 
Col.  Samuel  E.  Winslow, 

Commitfee  on  Interstate  Commerce, 

Iloxise  of  Representatives,  Washington,  D.  C. 
Dear  Sir:  May  I,  as  one  of  the  obstetricians  of  this  communitv.  suggest  that  there 
are  a  number  of  features  of  the  Sheppard-Towner  bill,  up  for  hearing  on  July  12, 
■which  are  being  received  by  the  medical  profession  in  a  most  unsympathetic  manner. 
Many  of  us  feel  that  this  measiu-e  is  quite  imnecessary,  particularly  as  applied  to 
the  majority  of  cities,  since  this  work  is  being  carried  on  at  the  present  time  in  an 
adequate  and  efficient  as  well  as  economical  way  by  the  hospitals  and  free  dispensaries, 
and  furthermore  that  it  is  a  matter  which  were  better  under  State  than  Federal  juris- 
diction if  it  must  he  "nationalized."  One  of  the  most  objectionable  features  of  it  is, 
so  it  seems  to  me,  the  provision  that  the  administration  of  the  act  should  be  placed  in 
the  hands  of  the  Childrens  Bureau,  which  is  mainly  a  social-service  organization  with 
its  medical  side  entirely  subordinate,  rather  than  to  place  it.  as  it  should  be,  under 
the  United  States  Public  Health  Service,  where  it  logically  belongs.  By  the  latter 
arrangement  the  administration  of  an  act  relating  to  the  care  of  pregnant  women 
would  be  medical,  as  is  obviously  proper. 

I  sincerely  hope,  as  do  others  of  my  profession,  that  this  bill  may  be  changed,  if  it 
is  to  become  an  actuality,  so  as  to  embrace  this  particular  matter  at  least.  Prenatal 
care  of  prospective  mothers  is  primarily  a  medical  matter,  whether  the  women  be 
poor  or  well-to-do,  and  neither  class  of  these  women  can  be  cared  for  as  they  should 
be  by  a  group  of  lay  social-service  workers,  especially  when  there  is  available  such  a 
medical  bureau  as  the  Public  Health  Service. 
I  beg  to  remain 

Respectfully,  yours, 

Paul  Titus, 
Obstetrician  Western  Pennsylvania  Hospital,  Pittsburgh,  Pa. 


Hon.  Samuel  E.  Winslow, 

Committee  on  Interstate  and  Foreign  Commerce. 
Dear  Sir:  I  am  sorry  to  have  to  enter  my  protest  to  the  Sheppard-Towner  bill  by 
written  word.  I  wish  I  could  l)e  in  Washington  to-morrow.  But  a  farmer's  wife  with 
three  babies  does  not  get  to  W^ashington.  A  cut  thumb  also  hampers  my  wirting,  so 
I  shall^ot  biuxlen  you  -with  much.  We  women  in  the  country,  educated  or  uneduca- 
ted (and  we  are  all  Americans  of  a  far  better  education  than  a  large  proportion  of  the 
city  population),  bring  our  babies  into  the  world  and  rear  them  with  the  minimum  of 
human  help,  medical  or  otherwise.  Those  of  us,  who,  like  myself,  have  some  hospital 
experience  try  to  help  the  others.  We  all  go  to  the  nearest  hospitals,  10  miles  away% 
when  we  can  manage  it.  If  we  did  not  have  to  pay  the  taxes,  if  Federal  appropria- 
tions fell  from  heaven,  as  most  socialists  and  social  workers  seem  to  think  that  they  do, 
we  should  like  to  see  Federal  money  available  to  help  us  build  our  own  little  county 
hospitals.  But  we  shall  get  them  somehow  anyhow  in  time,  and  we  know  that  educa- 
ting ourselves  and  our  neighbors  to  want  and  to  pay  for  them  and  for  a  decent  doctor  is 
worth  moi'e  to  our  children  than  any  Federal  agencies  for  nontechnical  instruction, 
which,  like  the  present  w^ell-intentioned  State  clinics  in  rural  districts,  would  slide 
like  water  ot'f  a  duck's  back.  There  is  jDlenty  of  instruction,  technical  and  nontech- 
nical, witliin  our  reach.    Moreover,  we  being  born  and  bred  Americans  of  many  genera- 


272  PUBLIC   PEOTECTIOX    OF   ZMATERXITT   AJXD   IXFAXCY. 

tions  don't  like  the  idea  of  a  governmeiit  that  makes  ever^-thing  its  business.  We 
think  a  pretty  plain  lesson  might  be  drawn  fi-om  Germany.  Their  statute  Ijooks 
were  full  of  compulsory  government  welfare  work  fi"om  the  cradle  to  the  grave.  And 
people  before  the  war  called  our  attention  to  their  fine  example.  We  know  what 
sort  of  State-reared  children  grew  into,  what  sort  of  State-reared  characters  in  the 
German  nation.  This  maternity  legislation  sounds  to  us  like  the  entering  wedge  to 
all  that  sort  of  government,  and  we  don't  want  it.  There  are  things  that  a  Children's 
Bureau  can  do.  It  can  get  and  publish  nation-wide  statistics  about  America.  We 
don't  support  it  to  tell  us  what  goes  on  in  Austria,  or  how  much  better  they  do  things 
in  5o^iet  Russia.  American  statistics  help  us  Americans  to  go  to  about  om-  work  of  im- 
proving America  in  a  characteristic  American  way.  Volunteer  work,  assisted  but 
never  controlled  by  city,  county,  or  State,  and  certainly  not  by  Nation,  has  solved 
many  of  our  health  problems  and  will  solve  others. 

I  won't  take  up  your  time  further  with  dissertations  on  government.  We,  in  the 
country  think  the  American  form  as  originally  conceived  very  fine  and  worth  keeping. 
And  don't  see  in  Prussia  or  Russia  any  improvement  on  it.  And  if  most  country 
women  could  crowd  yoiu"  committee  room  I  am  sure  they  would  ask  you  to  come  out 
like  American  men,  husbands  and  fathers  against  this  futile  and  dangerous  innovation 
in  the  name  of  the  mothers  and  babies  that  we  all  are  working  for. 
Yours,  sincerely, 

Margaret  Doane  Fayerweather. 


300  Ardmore  Avexue, 

Ardmore,  Pa.,  July  8,  1921. 
Hon.  Samuel  E.  Wixslow. 

My  Dear  Sir:  May  I  ask  your  consideration  of  the  inclosed  brief  resume  of  my 
reasons  for  opposing  the  Sheppard-Towner  bill  for  the  protection  of  maternity  and 
infancy,  and  may  I  suggest  that  they  may  be  brought  forward  at  the  approaching 
hearing  on  that  bill  or  incorporated  in  *he  report? 

The  statement  has  been  made  that  the  women  of  the  country  are  overwhelmingly 
in  favor  of  the  bill,  and  the  indorsement  by  the  women's  organizations  of  this  bill  is 
adduced  in  support  of  the  statement. 

In  point  of  fact,  one  at  least  of  the  associations  quoted  as  indorsing  it  has  no  authority 
under  its  charterto  take  action  on  such  a  bill.  I  refer  to  the  American  Federation  of 
University  Women,  of  which  I  am  a  member.  I  have  no  doubt  that  other  associations 
have  indorsed  the  bill  without  authority.  I  ought  to  say  that  this  may  have  been 
done  without  a  full  realization  of  the  inconsistency  of  the  action  with  the  purposes 
of  the  associations  as  expressed  in  the  charter. 

As  the  statement  has  been  made  that  the  bill  has  the  support  of  women  generally, 
it  becomes  important  that  those  of  us  who  are  opposed  to  it  should  register  our  objec- 
tions and  that  we  should  have  the  opportunity  of  offering  them  for  the  consideration 
of  the  committee  to  whom  the  bill  has  been  referred. 
Yours,  faithfully,  , 

Ida  Wood. 


Hon.  Samuel  E.  Winslow. 

My  Dear  Sir:  As  a  citizen  of  Pennsylvania  and  of  the  United  States.  I  urge  you 
to  vote  against  the  Sheppard-Towner  bill  for  the  public  protection  of  maternity  and 
infancy  and  providing  a  method  of  cooperation  between  the  Government  of  the 
United  States  and  the  several  States. 

Few  women  will  dissent  from  the  opinion  that  the  public  protection  of  maternity 
and  infancy  is  commendable:  that  the  bestowal  of  this  aid  should,  however,  take  the 
form  of  subsidies  granted  to  the  States  from  the  Federal  Treasury,  administered  by  a 
bureau  of  the  Department  of  Labor,  is  regarded  by  many  as  wrong  in  principle  and 
imwise  as  a  matter  of  political  expediency. 

It  is  v\Tong  in  principle  because  it  is  an  encroachment  upon  a  State  function:  for 
it  invests  in  a  Federal  bureau  of  the  Department  of  Labor  the  oversight  of  that  which 
is  properly  a  branch  of  the  public  health  service  of  the  State.  It  is  quite  true  that 
the  Federal  Government  has  in  recent  years  assumed  responsibilities  which  were 
never  contemplated  even  by  those  great  interpreters  of  the  Constitution  who  upheld 
the  doctrine  of  implied  powers:  the  assent  of  the  people  to  the  recent  measures  tend- 
ing toward  centralization  of  authority  in  the  Federal  Government  has,  however,  not 
been  invariably  whole-hearted,  and  there  are  not  wanting  indications  that  the  com- 
m.on  sense,  the  common  judgment  of  the  people  is  opposed  to  any  further  encroach- 
ment by  the  Federal  Government  upon  the  sovereignty  of  the  States,  with  the  conse- 
quent weakening  of  the  responsibility  of  the  States,  for  the  faithful,  judiciously 
economical,  succegsful  administration  of  their  affairs. 


PUBLIC  protectio:n'  of  mateeis^ity  and  infancy.         273 

It  is  politically  inexpedient  to  appropriate  any  money  at  this  time  for  new  under- 
takinijs  on  the  part  of  the  Federal  Government  or  to  enlarge  the  bureaucratic  adminis- 
tration. That  the  amount  involved  is  relatively  not  large  does  not  affect  the  main 
contention,  since  the  adoption  of  the  measure  involves  a  permanent  addition  to 
Government  expenditure,  a  permanent  extension  of  the  bureaucracy. 

The  public  is  unanimous  in  its  support  of  Secretary'  Mellon,  Secretary  Hoover,  and 
Gen.  Dawes  in  their  insistence  that  the  pre-election  pledges  shall  be  carried  out.  that 
there  shall  be  a  drastic  curtailment  of  Government  expenditure,  a  sweeping  bureau- 
cratic reorganization  in  the  interest  of 'economy  and  efficiency.  The  verdict  of  the 
people  at  the  polls  upon  the  administration  will  be  determined  by  its  fidelity  in  the 
fullillment  of  these  pledges,  and,  let  us  hope,  the  consequent  reduction  in  the  war 
taxation,  and  not  by  its  welfare  measures. 

During  the  discussion  of  the  measure,  however,  facts  have  been  brought  to  light  in 
regard  to  infant  mortality  that  are  significant,  and  the  ad\isability  of  some  public 
protection  of  maternity  and  infancy  has  been  shown.  If  the  numerically  powerful 
and  well-organized  associations  such  as  the  League  of  Women  Voters  and  the  General 
Federation  of  Women's  Clubs,  with  the  other  associations  that  ha^'e  been  active  in 
urging  Federal  legislation,  would  direct  their  concerted  action  upon  the  States,  there 
is  little  doubt  that  the  various  public  health  boards  would,  in  time,  without  special 
legislation,  proWde  for  the  hygienic  care  of  mothers  and  infants,  as  the  cit\-  of  Xew 
York,  through  the  action  of  its  board  of  health,  without  any  special  legislation,  has 
done  with  such  excellent  results.  On  the  other  hand,  there  is  more  than  a  presump- 
tion that  work  such  as  that  carried  forward  so  admirably  in  Xew  York  by  the  board 
of  health  for  the  protection  of  maternity  and  infancy  would  be  seriously  impaired  in 
its  efficiency  if  it  were  required  to  be  an  adjunct  of  a  child-welfare  department  in- 
stead of  one  manifestation  of  the  acti\"ity  of  the  board  of  health,  if  the  plans  for  its 
prosecution  were  subject  to  the  approval  of  a  Federal  bureau,  and  their  execution 
carried  forward  under  the  supervision  of  an  unsalaried  advisory  board,  one-half  of 
whose  members  at  least  must  be  women,  in  accordance  with  the  provisions  of  the 
Sheppard-T owner  bill. 

Ida  Wood. 

Ardmore,  P.\..  July  8,  1921. 

(The  following  are  a  few  of  the  typical  letters  received  from  organizations:) 

RACKEMANjr,  Sawyer  &  Brewster, 

Boston,  July  9,  1921. 
Hon.  Samuel  E.  Winslow, 

House  of  Representatives,  Washington,  D.  C. 
Dear  Mr.  Winslow:  I  believe  that  you  are  chairman  of  the  House  committee 
having  charge  of  the  Sheppard-T  owner  bill,  so  called,  which  is  pending  before  the 
Congress. 

I  should  like  permission  to  register  with  you  for  report  to  the  committee  at  som.e 
appropriate  time  the  strenuous  protest  of  the  Constitutional  Liberty  League  of  Massa- 
chusetts against  the  passage  of  this  act,  or  any  similar  legislation. 

At  the  recent  annual  meeting  of  this  league  held  in  Boston  this  bill  was  em.pha9iied 
as  one  of  the  things  which  the  league  wished  to  oppose.  Its  opposition  is  based  on 
the  following  grounds,  among  others: 

(1)  Such  legislation  is  paternalistic. 

(2)  As  drafted  and  presented  we  suppose  it  to  be  in  contravention  of  the  constitu- 
tional principles  of  our  Government. 

(3)  It  would  constitute  an  improper  and  unjust  infringement  of  the  rights  of  the 
several  States  to  govern  themselves  and  their  people. 

(4)  It  would  set  a  very  bad  and  dangerous  precedent  for  the  introduction  of  all 
kinds  of  miscellaneous  new  features  of  government. 

(5)  It  would  multiply  bureaus  or  departments  and  offices,  involving  very  consider- 
able and,  as  we  believe,  practically  useless  expense. 

(6)  It  would  not  only  infringe  the  rights  of  the  States,  but,  as  we  claim,  it  would 
afford  another  instance  of  taking  away  from  the  States  the  right  of  local  self- 
government. 

I  inclose  a  small  pamphlet  gi\"ing  the  names  of  most  of  our  members  and  also  our 
present  by-laws,  except  that  we  have  authorized  an  increase  in  the  board  of  directors. 
Please  accept  this  statement  as  given  in  behalf  of  the  league,  and  believe  me, 
\'ery  truly,  yours, 

Charles  S.  Kackemanx, 

Pres-ident. 

746.54—21 IS 


274  PUBLIC   PEOTECTION   OF   MATERNITY   AND   INFANCY. 

CONSTITUTIONAL   LIBERTY  LEAGUE    OF   MASSACHUSETTS. 

Officers:  Charles  S.  Rackemann,  president;  Ralph  Adams  Cram,  vice  president; 
Dr.  Charles  M.  Green,  vice  president;  Francis  Reginald  Bangs,  secretary;  Alexander 
Lincoln,  treasurer. 

Directors:  Thomas  Tileston  Baldwin,  Hugh  Bancroft,  Francis  Reginald  Bangs, 
Charles  B.  Barnes,  C.  W.  Barron,  Richard  deB.  Boardman,  John  T.  Burnett,  James 
D.  Colt,  Dr.  William  M.  Conant,  Louis  A.  Cgolidge,  Ralph  Adams  Cram,  Henry  R. 
Dalton,  Gordon  Dexter,  Edward  H.  Eldredge,  Asa  P.  French,  Irvin  McD.  Garfield, 
Dr.  Charles  M.  Green,  Robert  Sever  Hale,  Benjamin  D.  Hyde,  Lester  Leland,  Alex- 
ander Lincoln,  Amos  R.  Little,  Roger  B.  Merriman,  Hugh  Nawn,  Dr.  Franklin  S. 
Newell,  Patrick  O'Hearn,  Herbert  Parker,  Gen.  Samuel  D.  Parker,  Francis  Peabody, 
Charles  S.  Rackemann,  A.  C.  Ratshesky,  Dr.  Frederick  C.  Shattuck,  Dr.  Myles 
Standish,  R.  Clipston  Sturgis,  William  Roscoe  Thayer,  Bentley  W.  Warren,  Dr.  John 
Warren,  Moses  Williams,  Frederic  Winthrop. 

■  Constitution. 

ARTICLE   I — name   AND   LOCATION. 

The  organization  shall  be  known  by  the  name  of  "Constitutional  Liberty  League. " 
It  shall  be  an  unincorporated  association  of  Massachusetts  citizens.  Its  principal 
office  shall  be  in  the  city  of  Boston. 

ARTICLE   II — ^PURPOSES. 

To  conduct  a  campaign  for  the  education  of  the  people  in  the  evils  and  dangers  of 
national  prohibition  by  constitutional  provisions  and  laws  of  Congress,  to  promote 
temperance  in  the  use  of  alcoholic  beverages,  and  to  secure  the  proper  regulation  of 
the  liquor  traffic  by  the  State  in  the  exercise  of  the  local  police  power. 

With  these  ends  in  view,  to  secure  the  annulment  or  repeal  of  the  eighteenth  amend-  ^ 
ment  and  the  repeal  of  the  Volstead  law,  to  oppose  any  unreasonable  and  oppressive   " 
Federal  or  State  law  or  action  designed  to  enforce  the  amendment,  and  to  support 
the  passage  of  State  laws  authorizing  the  sale  of  beer  and  wine. 

In  all  proper  and  lawful  ways  to  influence  public  opinion,  to  the  end  that  the  stand- 
ards of  personal  liberty  of  thought  and  conduct  which  were  established  by  the  founders 
of  the  Government  of  the  United  States  of  America  shall  be  maintained  and  safe- 
guarded. 

To  oppose  any  impairment  of  the  rights  of  American  citizens  as  vested  in  them  by 
the  first  10  amendments  of  the  Constitution  of  the  United  States,  or  by  the  Constitution 
itself. 

ARTICLE   III MEMBERSHIP. 

All  persons  interested  in  these  purposes  except  persons  financially  interested  in  the 
liquor  traffic  shall  be  eligible  to  membership  in  the  association. 

ARTICLE    IV CLASSES    OP   MEMBERSHIP. 

There  shall  be  two  classes  of  membership:  (a)  Active,     (b)  Associate. 

Active  members  shall  consist  of  those  who  are  willing  to  assume,  to  some  extent, 
the  financial  obligations  which  must  be  met  in  order  to  carry  out  the  purposes  of  this 
association. 

Associate  members  shall  comprise  those  whose  sympathy  and  interest  are  in  line 
with  the  organization,  but  who  may  not  wish  to  become  active  members. 

Active  members  shall  be  elected  by  the  executive  committee.  Associate  members 
shall  be  deemed  to  be  elected  in  the  discretion  of  the  executive  committee  on  pay- 
ment of  the  annual  dues.  Each  class  of  members  shall  pay  dues  as  determined  by 
the  board  of  directors. 

Any  member  may  be  suspended  or  expelled  from  the  association  by  the  executive 
committee  at  any  time,  either  for  nonpayment  of  dues  or  for  any  conduct  deemed  by 
the  executive  committee  to  be  detrimental  to  the  interests  of  the  association. 

All  classes  of  members  shall  have  a  right  to  vote  for  officers  and  upon  amendments 
to  this  constitution. 

ARTICLE   V OFFICERS. 

The  officers  shall  be  a  president,  two  vice  presidents,  a  treasurer,  and  a  secretary.  L 
These  officers,  together  with  not  less  than  11  nor  more  than  40  additional  members,  1^'^' 
■hall  constitute  the  board  of  directors.    The  officers  and  directors  shall  be  elected  at 


i 


PUBLIC   PROTECTION    OF   MATERNITY   AND   INFANCY.  275 

the  annual  meeting  of  the  association,  and  shall  hold  their  respective  offices  until 
their  successors  are  elected  and  have  qualified. 

The  management  and  control  of  the  affairs,  funds,  and  property  of  the  association 
shall  he  vested  in  the  board  of  directors. 

The  secretary  shall  keep  the  records  of  the  association  in  books  belonging  to  it.  and 
shall  perform  all  customary  secretarial  duties. 

The  treasurer  shall  collect  and  receive  all  moneys  due  and  payable  to  the  associa- 
tion, and  deposit  them  in  surh  bank  or  trust  company  as  the  executive  committee 
may  from  time  to  lime  approve.  If  so  required,  from  time  to  time  by  the  executive 
committee,  the  treasurer  shall  give  bond  with  a  surety  company  as  surety,  in  such 
sum  as  said  committee  may  direct;  the  expense  of  such  bond  to  be  paid  by  the  asso- 
ciation. 

The  accounts  of  the  treasurer  shall  be  audited  annually  V)y  a  special  committee 
appointed  by  the  executive  committee,  but  not  including  any  members  of  the  execu- 
tive committee. 

In  general  the  duties  of  the  officers  shall  be  those  customarily  pertaining  to  their 
respective  offices,  with  such  special  duties  as  may  be  assigned  by  -the  executive 
committee. 

ARTICLE   VI — EXECUTIVE    COMMITTEE. 

The  board  of  directors  shall  elect  annually,  at  a  meeting  as  soon  after  the  annual 
meeting  of  the  association  as  reasonably  may  be.  an  executive  committee  which  shall 
consist  of  seven  members.  The  executive  committee  shall  ha^e  direct  supervision, 
control,  and  direction  of  the  officers  of  the  association,  and  shall  have,  in  the  interim 
between  meetings  of  the  board  of  directors,  all  the  powers  and  shall  perform  all  the 
duties  of  the  board  of  directors.  Vacancies  in  any  office  shall  be  filled  by  the  execU' 
tive  committee. 

ARTICLE    VII MEETINGS. 

The  meetings  of  this  association  shall  be  annual,  the  time,  place,  and  program  to  be 
arranged  by  the  executive  committee.  Special  meetings  may  be  called  by  the 
executive  committee. 

Meetings  of  the  board  of  directors  may  be  held  at  such  time  and  place  as  they  may 
determine  and  may  be  called  by  the  president  or  vice  president  on  written  or  printed 
notice  sent  by  mail  to  each  director.  Nine  members  of  the  board  of  directors  shall 
constitute  a  quorum. 

Meetings  of  the  executive  committee  may  be  held  at  such  time  and  place  as  they 
may  determine  and  may  be  called  by  the  president  or  Adce  president  on  written  or 
printed  notice  sent  by  mail  to  each  member  of  the  committee.  Four  members  of  the 
committee  shall  constitute  a  quorum. 

ARTICLE    VIII BY-LAWS. 

The  board  of  directors  shall  have  full  power  to  adopt  and.  from  time  to  time,  to 
modify  by-laws  governing  the  operation  and  management  of  the  association. 

ARTICLE    IX AMEXDMEXTS. 

This  constitution  may  be  amended  at  any  annual  or  special  meeting  of  the  associa- 
tion by  a  three-fourths  vote  of  the  members  present  and  voting:  the  proposed  amend- 
ment having  l^een  approved  by  the  executive  committee  and  submitted  to  the  mem- 
bers in  writing  before  such  meeting. 

Southwest  Journal  of  Medicine  and  Surgery, 

OUahoma  City,  OUa.,  July  12.  1921. 
Hon.  Samuel  E.  Winslow, 

Chairman,  House  Office  Building.  Washington.  D.  C. 

Dear  Sir:  It  has  just  come  to  my  attention  that  the  Sheppard  maternity  bill  is 
to  come  before  your  honorable  committee  for  consideration.  As  the  representative 
of  more  than  10,000  active  practicing  physicians  of  this  great  southwest  country,  I 
want  to  express  the  hope  that  you  will  report  unfavorably  upon  this  bill. 

The  reasons  are  these : 

First.  It  is  the  universal  opinion  of  all  physicians,  so  far  as  I  can  learn,  who  have 
given  this  matter  any  study,  that  this  is  the  entering  wedge  looking  to  State  medicine. 
I  am  sure  that  this  country  is  not  yet  ready  to  copy  after  Austria  in  adopting  State 
medicine . 

Second.  The  financial  burden,  which  this  would  entail  if  carried  to  a  point  where 
it  would  be  of  the  slishtest  service  to  this  countrv  at  large,  would  be  as  much  as  that 


276  PUBLIC   PEOTECTION    OF   MATERNITY   AND   INFANCY. 

which  is  being  asked  for  at  present  for  the  soldiers  of  the  World  War,  and  we  are 
informed  by  the  authorities  at  Washington  that  the  country  can  not  assume  such  an 
obligation  as  that  at  present ;  in  the  face  of  that  is  it  consistent  for  us  to  give  consid- 
eration to  a  project  which  is  purely  an  experiment  and  of  a  doubtful  character 
even  at  that. 

As  the  representative  of  the  physicians  of  Missouri,  Kansas,  Texas,  Arkansas,  and 
Oklahoma,  I  beg  of  you  that  you  will  not  make  a  favorable  report  upon  this  bill  at 
this  time. 

Very  respectfully, 

Fred  H.  Clark, 

Secretary-Editor. 

Massachusetts  Public  Interest  League, 

Boston,  Mass.,  July  9,  1921. 
Hon.  Samuel  E.  Winslow, 

Washington,  D.  C. 
Dear  Sir:  I  hope  the  Sheppard-Towner  bill  will  be  reported  unfavorably  by 
your  committee,  for  I  consider  it  paternalistic,  futile,  and  extravagant.  The  States 
are  able  to  take  care  of  their  mothers  and  babies  without  Federal  aid;  the  provisions 
of  the  bill  would  accomplish  no  vital  good;  although  an  appropriation  of  a  million 
and  a  half  dollars  is  comparatively  small,  it  represents,  nevertheless,  a  good  many 
hard-earned  dollars  paid  in  taxes.  This  is  no  time  for  unnecessary  appropriations, 
however  small. 

Yours,  very  truly, 

Mrs.  Frank  B.  Sanborn, 
President  Riverside  Neighborhood  House  Association. 


Maryland  Association  Opposed  to  Woman  Suffrage, 

Baltimore,  Md.,  July  9,  1921. 
Hon.  Samuel  E.  Winslow, 

Washington,  D.  C. 

Dear  Sir:  As  an  organization  representing  conservative  women  who  stand  with 
the  right-minded  men  and  realize  our  interests  are  identical  and  that  there  can  be  no 
such  thing  as  women's  legislation,  we  wish  to  call  your  attention  to  the  fact  that  though 
we  may  seem  to  be  inarticulate  because  we  maintain  no  lobbies  in  Washington  and 
do  not  bring  direct  pressure  on  Congressmen,  yet  in  the  last  election  we  stood  with  our 
men  and  spoke  in  no  uncertain  terms. 

We  believe  that  you  gentlemen  whom  we  sent  to  represei^t  us,  because  we  relied 
on  your  wisdom  and  judgment,  will  protect  us  from  the  type  of  legislation  that  is 
expressed  in  the  Sheppard-Towner  bill.  We  feel  that  the  purpose  of  the  Federal 
Government  is  to  stimulate  but  not  subsidize  and  that  when  it  does  the  latter  it  is 
disregarding  the  principles  which  have  made  us  a  great  Nation.  No  obscuring  sen- 
timentalism  can  save  us  after  we  once  begin  to  create  a  paternalism  in  place  of  the 
real  democracy  that  was  given  us  by  our  fathers. 

We  want  to  warn  you  against  being  forced  into  action  on  the  ground  that  "  10,000,000 
women  are  demanding  the  passage  of  the  Sheppard-Towner  bill."  A  high-handed 
way  has  been  found  of  stampeding  organizations;  a  small  group  will  claim  that  they 
speak  for  thousands,  and  on  investigating  you  will  find  that  these  groups  are  made 
up  of  childless  women  whose  interference  would  be  resented  by  the  mothers  of  America 
if  they  knew  that  the  G  o  /ernment  was  being  urged  to  put  mothers  on  its  pay  roll  and  to 
make  children  the  wards  of  the  State. 

We  look  to  you  to  protect  us  from  any  such  intolerable  situation,  and  earnestly 
hope  that  our  confidence  will  be  justified. 
Very  truly,  yours, 

Cornelia  A.  Gibbs,  President. 

New  Hampshire  Medical  Society, 

Concord,  N.  H.,  July  22,  1921. 
Hon.  S.  E.  Winslow, 

Washington,  D.  C. 
Dear  Mr.  Winslow:  The  New  Hampshire  Medical  Society  at  its  annual  meeting 
in  May  adopted  resolutions  in  its  house  of  delegates  by  unanimous  vote  "emphati- 
cally opposed  to  State  medicine  and  all  such  schemes,  or  either  wholly  or  partly  con- 
trolled, operated,  or  subsidized  by  the  State  or  National  Government." 


PUBLIC  PROTECTIOlSr   OF   MATERNITY  AND  INFANCY.  277 

The  Sheppard-Towner  so-called  maternity  Inll  is  included  most  assuredly  in  this 
resolution. 

The  American  Medical  Association  in  meeting  in  Boston  June  10-14  through  its 
legislative  Ijody,  the  house  of  delegates,  was  unmistakably  oj)posed  to  anything 
bordering  on  ))aternalistic  legislation  and  so  expressed  itself.  I  had  the  honor  to  be 
New  Hanipshire  delegate  to  that  asseml)ly  and  voiced  the  sentiments  of  the  physi- 
cians of  this  State. 

We  protest  against  such  destructive  measures  in  the  name  of  the  highest  interests 
of  Nation  and  public  health,  and,  fully  realizing  the  grave  dangers  that  would  fol- 
low enactment  of  such  ideas  into  law,  earnestly  ask  you  to  extend  your  recognized 
influence  in  behalf  of  justice,  society,  and  recognition  of  the  demands  of  a  great, 
scientific,  puljlic-spirited  profession. 

1  have  the  honor  to  be. 

Most  respectfullv,  yours, 

(Dr.)  I).  E.  Sullivan. 

Massachusetts  Civic  Alliance, 

Boston,  May  20,  1921. 
Hon.  Samual  E.  Winslow, 

Chairman  Committee  on  Interstate  and  Foreign  Commerce, 

House  of  Representatives,  Washington. 

Dear  Sir:  I  have  the  honor  to  convey  to  you  the  following  in  evidence  of  the 
strong  public  sentiment  and  official  protest  against  maternity  benefits  legislation  and 
the  pending  bill. 

Social,  charitable,  and  child-welfare  societies  in  report  of  the  Massachusetts  In- 
vestigating Commission  (House,  No.  1835,  Dec,  1920,  p.  20),  two  health  investigating 
commissions  of  the  State  of  Hlinois,  and  the  Civic  Federation  of  Chicago,  after  thorough 
investigations  report  that  there  is  no  necessity  for  the  maternity  legislation. 

Maternity  bills  in  the  Massachusetts  Legislature  were  rejected  last  year  by  the 
emphatic  majority  of  140  to  20;  and,  this  year,  after  State-wide  investigation  by  a 
State  commission,  the  maternity  bills  were  rejected  unanimously,  except  that  two 
members  retained  their  rights  to  dissent.  Both  house  and  senate  sustained  the 
adverse  reports  of  the  committee,  practically  unanimously. 

Most  significant  of  all  is  the  uprising  of  the  physicians  of  the  United  States.  The 
Chicago  Medical  Society,  the  Illinois  Medical  Society,  the  Medical  Association  of 
the  Southwest,  comprising  the  physicians  of  Missouri,  Kansas,  Oklahoma,  Arkansas, 
and  Texas,  and  every  medical  society  in  Massachusetts  are  active  in  demanding 
that  maternity  benefits  legislation  should  not  be  enacted. 

Their  reasons  have  been  tersely  expressed  to  the  Illinois  Legislature  by  Dr.  W.  D. 
Chapman,  officially  representing  the  Illinois  State  Medical  Society  in  opposition  to 
a  bill  to  carry  out  the  Sheppard-Towner  maternity  bill's  requirements,  as  follows: 
"They  open  1;he  door  to  State  medicine  and  encourage  the  socialistic  philosophy  that 
the  citizen  should  be  dependent  upon  the  State." 

In  our  office  in  Boston  are  the  signatures  of  800  physicians  of  Massachusetts  who 
this  year  have  signed  a  postal  card  sent  to  them  by  the  Massachusetts  Civic  Alliance 
relative  to  their  attitude  on  the  maternity  benefits  bill.  Only  14  signed  in  favor,  and 
over  775  signed  in  opposition  to  State  maternity  benefits.  The  card  they  signed  is 
inclosed.  Their  reasons  are  briefly  and  too  inadequately  expressed  by  65  doctors  on 
the  inclosed  sheets. 

A  serious  feature  of  State  care  in  maternity  is  the  tendency  to  lower  the  standards 
of  medicine,  as  in  Germany  and  Great  Britain  they  have  been  lowered,  through  some- 
what similar  legislation.  When  the  inspiration  and  zeal  of  that  matchless  calling 
shall  ba  dampened  through  bureaucratic  interference  young  men  will  not  be  attracted 
to  enter  its  folds,  and  the  welfare  of  mothers  and  children  will  suffer. 

The  American  Medical  Association,  to  which  every  State  medical  society  in  the 
United  States  belongs,  unanimously  adopted  a  resolution  at  New  Orleans  last  summei 
in  which  it  "declares  its  opposition  to  *  *  *  medical  ser\dces  *  *  *  pro- 
vided, controlled,  or  regulated  by  any  State  or  Federal  Government. 

The  Republican  national  platform  turned  down  the  plank  for  maternity  legislation. 
The  General  Federation  of  Women's  Clubs,  haxing  2,000,000  members,  refused  to 
indorse  the  maternity  bill  at  their  biennial  meeting  in  Des  Moines  last  summer. 
Catholic  and  Protestant  forces  are  against  it.  No  fraternal  society  asks  for  it.  Mothers 
are  dreading  it. 

The  active  propaganda  in  its  favor  has  kept  hidden  facts  which  the  census  reveals, 
that  infant  mortality  has  steadily  lowered  in  the  registration  area  of  the  L'l'nited  States. 
In  Massachusetts  the  deaths  of  infants  under  1  vear  of  age  has  been  reduced  from  132 


278  PUBLIC  PEOTECTIOX   OF   MATEEXTET  A^D  IXFAXCY. 

to  each.  I.ChDO  births  10  years  ago  to  S2  last  year.  The  proponents  injure  American 
motherliood  by  advertising  falsely  that  thousands  of  lives  are  needlessly  thrown  away. 
They  do  not  tell  us  that  the  fatalities  of  childbirth  are  only  one-half  to  six-tenths  of 
1  per  cent  of  the  mothers  having  children.  One  effect  of  th<=>ir  erroneous  teaching  is 
to  make  expectant  mothers  dread  the  ordeal  or  to  resort  to  birth  control.  The  latter 
is  actually  taught  in  a  pamphlet  issued  by  an  advocate  of  the  legislation  in  the  employ 
of  a  life  insurance  corporation,  who  was  also  employed  by  the  Massachusetts  Maternity 
Commission  as  consulting  statistician.  They  even  have  charged  legislators  with 
guiltiness  of  the  losses  of  life  in  childbirth  for  not  passing  their  legislation. 

Statistics  prove  that  there  is  no  country  in  the  world  ha-\-ing  so  large  a  colored  popu- 
lation, with  such  heterogeneitT."  of  the  people,  and  ha^•ing  such  severe  climatic  changes 
as  the  United  States,  which  can  compare  with  our  low  rates  in  infant  mortality". 

The  reasons  behind  the  legislation  are  political.  It  is  mothered  by  political 
organizations.  It  will  enable  positions  to  be  created  that  it  may  be  possible  to  use 
in  rewarding  and  gi'^'ing  new  life  to  organizations  which  no  longer  are  inspired  by  the 
"Votes  for  Women"  slogan  since  the  nineteenth  amendment  took  from  them  that 
mission. 

They  have  advertised  words  of  the  President  as  indon-ement  of  the  bill.  Careful 
reading  shows  no  such  indorsement,  but  general  observations  only,  such  as,  wise  or 
unwise,  society*  disposes  to  do  certain  things,  that  strongly  supported  the  bill  may 
pass,  etc. 

We  plead  for  return  to  early  standards  of  self-reliant  parenthood,  the  fulfilment  of 
nati\"it>'  vows  by  men  making  them  at  the  altar  and  not  by  the  State's  relie\±ng  the 
husband  from  them,  and  for  the  perpetuation  of  the  priceless  institution  of  the  family 
physician,  which  abroad  has  too  largely  disappeared  to  make  plaea  for  the  panel 
doctor.  And  we  ask  that  the  bill  may  not  be  reported  favorably. 
Respectfully, 

The  Massachusetts  Civic  Alliaxce, 
Ebex  W.  Buexstead,  Secretary. 


The  Massachtsetts  Medical  Societt, 

Boston,  July  8,  1921. 
Hon.  Samitel  E.  Wixsxow, 

House  of  Representatices,  Washington,  I).  C. 
Deae  Sib:  At  the  instance  of  our  president.  Dr.  John  W.  Bartol.  of  Boston.  I  am 
sending  vou  a  vote  passed  at  the  annual  meeting  of  the  governing  body  of  our  society. 
the  council,  on  ^lav  31.  1921,  with  reference  to  the  Sheppard-Towner  matemitv  aid 
biU,  S.  1039. 

Respectfully,  vouk, 

Walter  L.  Buerage.  Secretary. 


Voted.  That  the  Masachusetts  Medical  Society,  through  its  council,  hereby  ex- 
presses its  disapproval  of  the  Sheppard-Towner  maternity  aid  bill.  S.  1039.  now 
before  the  United  States  Senate.  The  bill  does  not  intrust  the  proposed  aid  for 
mothers  and  infants  to  the  medical  profession,  but  to  the  Children's  Bureau  of  the 
Department  of  Labor,  which  does  not  possess  the  scientific  knowledge  and  qualifica- 
tions necessary-  to  protect  mothers  and  infants. 

A  true  copy. 

Attest : 

W.  L.  Buerage,  Secretary. 

(Thereupon,  at  5  o'clock  p.  m.,  Saturday,  July  23.  1921.  the  hearings  were  con- 
cluded.; 


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